Saturday, February 9, 2019

How to Get Reimbursed for Lactation Consultations!


How to get Reimbursed!

1.     Call your insurance and find out if they are contracted with anyone locally who is an IBCLC. You are entitled to lactation consultation under your insurance (as long as not grandfathered in and true insurance) under the ACA (affordable care act). This is a preventative maintenance under mom’s insurance, not baby.
2.    
      When reimbursed it is required to be as if you saw someone in-network since this is an ACA provided service.
3.    
      For UNITED HEALTHCARE.
a.       You have two options:  
                                                               i.      See who you like and file for reimbursement afterwards and see what they do.
                                                             ii.      Call and begin a GAP exception. All info. needed to file for this can be found below.
4.     
      For all other health insurance. Explain that you need to see an IBCLC, not a CLC, RLC, or other number of letters that may be out there. An IBCLC is standard of care for lactation consultation. Explain who you would like to see IBCLC and follow their guidelines for how to file. 

      In most cases you will file a form provided after seeing an IBCLC. Reimbursement may not be the same as charges since in many cases charges include online, text, and phone support which are not covered by insurance.
5.    
         Info needed for GAP exception or other paperwork prior to consultation.
a.       Provider Name:
b.       Provider NPI :
c.       TAX ID: 
d.       Company Name: 
e.       Diag Code: 
f.        Billing codes: 
g.       If they need a range of visit time put in 6-8 weeks then you will not have to file again.



Good Luck and Be Strong, Lactation Consultation is your Right!

Thursday, August 3, 2017

My Breastfeeding Journey: Twins and Tongue Tie

I started writing this story in February of 2016 right after my babies turned one… I finished it World Breastfeeding Week 2017, just after my sweet toddlers turned 2.5.

In February of 2016 I started with this introduction:

In order to write this story I had to find time when both teething, nursing stuffy nosed breastfeeding boys were asleep and turn on my now defunct windows phone (my best friend through the entire pregnancy and first year of mommyhood). Like the rest of the world I remember some details and have truly forgotten others and the timeline of events of our first year exclusively breastfeeding twins.

In August of 2017 I finished writing the story after a marvelous day at the beach during our summer break in Massachusetts. I finished it while my two active toddlers were watching their favorite videos while they fought the dreaded night sleep.

How much things have changed, and how much things change when you are a breastfeeding momma.

My twin boys were born vaginally at 39 4/7 weeks with an amazing OB and birth team that included great friends, a fabulous doula, and one special OB tech in the OR who silently cheered me on from across the room and was my focus as I pushed my babies out.

Samuel arrived first, 7lb 4oz, Sydney second, 5lb 9oz. It was a good but challenging birth for all and after some quick assessment by the birth team both went to breast in the delivery room without any challenge or concerns. I was then wheeled out back to my room with both babies on me. We rolled into out room and the boys met their support, village, aunties and grandparents.

Both breastfed well in that early time after birth. My epidural had only been running for about 6 hours prior to their birth and the pitocin prior to birth was limited greatly, nothing post delivery was given by IV.

The rest is a fog..but what I do remember is…

Samuel breastfed like a champ that first 24 hours. Sydney just seemed to have trouble finding the latch. I let them both crawl to breast multiple times and with time and practice Sydney crawled his way to a good latch around 12 hours of age.

I looked closely at both of their tongues and thought…oh geez we got ties….but nothing that can be clipped….and moved on through the day or night or whatever time it was. The twin zone had begun.

Both boys had great output in the first 24 hours, no concerns for rising bili levels, jaundice and we were discharged around 30 hours postpartum. I remember leaving the hospital and turning to my mom and saying.. ‘I feel like we just robbed a bank! I just had term twins, vaginally, with a discharge just after 24 hours in Las Vegas! Amazing!’ I was so happy to be headed home with these bundles of joy.

That first night home….

Soreness and lots of it. I grabbed those nipple shields right when I got home and I didn’t look back. This girl was not gonna go the way of bleeding blistered nipples…no thank you!

The interesting part that follows is…

I remember Sydney as my piranha baby and throughout that first year of life he had less gain and had to work harder for that flow and weight gain when breastfeeding.

My texts from that first week tell another story for the early days. At 2 days of age after my first at home picture post, my pediatric dentist notices a nipple shield on both babies. I respond Samuel is a piranha and Sydney is off the shield. Interesting as this is totally opposite of what I remember. But the text is the truth, right? The texts continue as I assess and reassess. Samuel has his first chiropractic appointment around 5 days old, as I note how tight he is, and he has surgery for an inguinal hernia coming up on day 7. At 6 days of age I note a posterior tie in Samuel, no observation concerns for Sydney. At 3 weeks of age the boys are actively going to CST. We have their first pediatric dentist visit at 3 weeks. Following my protocol and practice, which has now changed thanks to these two beautiful babies, I agree to postpone revision despite my pain and the breastfeeding challenges and continue with the CST and revisit in a few weeks. At this point Samuel is still on the shield, a week later I am able to wean him but as is common with posteriorly tied infants he is leaking milk out the side of his mouth while feeding without the shield.

At 4 weeks, the pain is still present. Sydney is now notably more painful than Samuel. At 5 weeks I reach out to a colleague who gives me the standard advice of trying to latch both babies deeper and keep them latched deeper without the shield. I try this, 72 hours off the shield for both.

My memory of this 72 hours is clear as it ever can be. I remember almost every day around 4 or 5 pm being sore and irritated and feeling just plain old defeated. I reached a point of feeling like the hope wasn’t there, the pain was irritating, intolerable, and interruptive. I wanted to just feed my babies and enjoy this time and not worry about when that evil soreness was going to return. I also seemed to notice around this time that I was chasing supply. Sydney was not gaining like Samuel was and tandem seemed to help him get the letdown, the flow, better. Frustration doesn’t begin to describe where I was at during this time. I stopped the CST somewhere around this time since it wasn’t getting better and the trip was taking a toll emotionally and physically on all of us. The IBCLC curse, it had arrived.  Placenta pills and village support to the rescue and a deep breath.

For the next few weeks, I keep breastfeeding with and without the shield. I keep watching for letdowns and feeding often and focusing on supply. At almost 2 months of age I notice Sydney is not gaining as well as Samuel and the pain when he feeds is starting to limit the time I allow him to stay at the breast. We return to the chiropractor and start again. I assess Sydney noting his suck is not appropriate- a bite with no forward movement. I also note he needs Samuel on to transfer well. I am still compressing throughout feeds and tandem feeding through the night. I am going as far as clearing Sydney’s nose to make sure he is feeding well. After our CST visit that day, amazing improvement in Sydney. He can breastfeed! But, this is short lived and the old piranha baby returns shortly after this visit. I continue the CST and the pattern continues. I keep doing what I need to do, but things aren’t changing.

At almost 3 months of age, I notice Sydney is minimum gaining, 5oz a week, is fussy at the breast, popping on and off and just plain not enjoying breastfeeding and neither am I (okay I admitted it). Despite how much I am not enjoying this process, I am still on the fence about revision. I have no one to talk to in my black hole, or my cliff, or my island, or whatever you want to call it. I do the best I can do and call a colleague. I talk to her by facetime. She watches me feed my baby, we talk, we try a few things, she gives me some exercises and it feels better. Relief! The magic bullet! The breastfeeding fairy! She explains, as I have to so many clients, that revision is necessary. These exercises are important and are helping but they are not fixing the root cause. I do as she has told me and things stay better post exercises for the next 24 hours. I talk with her again 24 hours after our first chat and ask if I really need to do the revision, she encourages me to revise. The exercises aren’t the answer, revision is.

A few days later both boys are revised, lip and tongue. It was amazing and felt so much better afterwards! We left the pediatric dentist, got food, I breastfed again- in my car as I had been doing for months already- and then went to CST. From this day forward things got infinitely better! I became less frustrated. Samuel fed better all the time, Sydney took some time but in 4-6 weeks he was feeding better and feeling better at the breast. I was overfull 24 hours post revision! The soup, the oatmeal, the golacta, the brewers yeast (yuck), the shakes, the chicken… they had all worked but now I could relax, enjoy and feed my babies. This is what breastfeeding is supposed to be, and so it was.

We made our way through that first year with ups and downs and weight checks at home biweekly and then weekly as all who have a history of dealing with tongue tie often do. Teething brought on biting and irritation with feeding for both. Sydney oscillated between feeding well and needing encouragement. But this was a journey, our journey, and as a family we made it. At 26 months and a few weeks, after an amazing breastfeeding path, weaning arrived and our new journey as a family of sleeping through the night toddlers arrived.

In the end, no matter how much you know or think or feel, having someone else coach you and guide you to a better you, a better family, a better journey is so very important in this motherhood journey. My biggest take away, don’t be afraid to reach out and ask for help because that special person is waiting for that call and what they have to say may change your journey and many others.



Thank you to EVERYONE who supported me and us as a family on this amazing journey. Thank you to my beautiful boys for pushing me to keep searching for better answers, better solutions, and better options for them and for other breastfeeding/chest feeding moms and babies. 

Lisa Weinshenker, RN, IBCLC
Breastfeeding and Babies, Yeah!
www.breastfeedinglv.com

Tuesday, May 7, 2013

An open letter to the medical community regarding breastfeeding, insurance coverage, and our country's public health issues.



To the medical community that supports moms and babies:

As an Internationally Board Certified Lactation Consultant (IBCLC) and owner of Breastfeeding and Babies, Yeah!, www.breastfeedinglv.com ,  I have decided to take this time to write an open letter to all in the medical community to make sure that all physicians are aware that under the new AFFORDABLE CARE ACT (ACA) almost all moms who have private insurance have Lactation Consultation Coverage at 100% coverage with no deductible and no copay. All Medicaid moms qualify for WIC and are able to receive assistance from an IBCLC at many local WIC offices throughout the city. 

Breastfeeding, unlike formula feeding, is a process that is best handled through PREVENTATIVE CARE. 

Lactation challenges are best handled by a trained professional who is board certified. This is part of the reason Lactation Consultation, by an IBCLC, is covered by insurance, and IBCLCs are now contracted providers under the ACA.

Breastfeeding unlike formula feeding is time sensitive based on hormones produced at birth. Best outcomes, with mom’s who desire to breastfeed, are most often seen when small challenges are recognized either prenatally, while still in hospital on postpartum, or within the first few days of a mom noticing supply changes or latching challenges.

I would like to personally encourage any and all physicians to refer all families that desire to breastfeed, are being asked to supplement, or have identified fertility issues or a history of lactation challenges directly to their insurance or to the local breastfeeding coalition’s list for a referral to a local IBCLC for proper preventative lactation care. 

All moms who are being asked to supplement should also be pumping postfeed, most often with a hospital grade pump for adequate stimulation and emptying of the breast. Resources for pump rentals are also noted on this often noted on this resource list as well.  

If you have any questions, please feel free to contact your local breastfeeding coalition or your local La Leche League leader. If we all work together than we can all together assist families reach their personal breastfeeding goals and follow the AAP guidelines of breastfeeding of infants for the first six months of life.

                                                                                                               

Monday, April 29, 2013

What is an ACA (Affordable Care Act) Breast Pump?

All of the dust has settled and now we all, healthcare professionals and families, are asking,

"What is this affordable care act stuff and what is my coverage?"

For Women's preventative services the Affordable Care Act (ACA) covers multiple items. The article found at ACA coverage  sums everything up nicely and summarizes your coverage as a breastfeeding mom with "Breastfeeding support, supplies, and counseling: Pregnant and postpartum women have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies." 

So, how do you take advantage of this? It really is an easy process.

1. Get your insurance card out. Look on the back and call the customer service number. Give them your ID and other information they request and ask: "What is my coverage for a personal ELECTRIC pump? "

2. The next questions is: "Where can I get this pump from?" The insurance company should be able to give you list of providers or DME offices they are working with.

3. The pump you receive will be a special ACA pump. It will more than likely come in a brown box with the company name on it- Medela, Ameda, Hygeia - and should contain a personal electric pump with a pump kit for your personal use.

Now I have my pump, but what if I need follow up with breastfeeding challenges?

Again, this is covered under ACA. To find out your coverage follow these steps.

1. Get your insurance card out. Look on the back and call the customer service number. Give them your ID and other information they request and ask: "What is my coverage for lactation consultation with an IBCLC?"

2. Find out what your coverage is specifically: Is it prior to deductible, after deductible? Is it different in network vs out of network? What is your copay amount? How many visits do you have at this rate?

3. The next questions is: "Who do you have as listed Lactation Consultants that I may see?" The insurance company should be able to give you list of providers and their direct contact information as well as their websites. These providers have been credentialed by the insurance company and carry an NPI so they may bill insurance.

4. Make sure to do your homework! Just because a provider is listed doesn't mean they are the best available. Like many do for other healthcare professionals be diligent. Check YELP, Yahoo, etc.  for reviews and go to the providers website if provided. References should be available in one or both of these locations. You can also check the providers licensure status at the IBCLE site at IBCLC registry


Other hints to help you navigate this process:

1. DO this work prior to delivery. KNOW your benefits before the pump or consult is needed. It is always easier to deal with this preventatively rather than reactively.

2. CALL your hospital and find out who their IBCLC is and how long they typically spend with a patient in L&D and on Postapartum. If the answer is 15 min or less and that their hours are Mon-Fri 8-5 then make contact with your insurance company's IBCLC ahead of time. When the time comes you will be glad that all you needed to do was let them know you have delivered and could they come and guide you through to your successful path.

3. DON'T be afraid to ask questions. ACA has included coverage for breastfeeding moms for a reason. The AAP as well as the Surgeon General as well as your government are making this a priority and they want you  to do the same.

Best wishes and if you are in the Las Vegas area and need guidance please feel free to look us up at http://Breastfeeding and Babies, Yeah!  .

-Lisa Weinshenker, RN, IBCLC

Tuesday, April 23, 2013

The Cost of NOT Breastfeeding?

Yes, there is a cost of not breastfeeding. It comes in many forms from the cost of formula, to the cost of sickness to the baby and to the mom, to the cost to your company or the medicaid system for the illnesses caused by not providing what your baby needs through breastmilk,  to the cost of emotionally feeling like you did not achieve your desired path.

First, the cost of formula.
1. The cost of a consult without insurance can be anywhere from $80-400 depending on where you live and the standard cost of a consult with an IBCLC in the area where you live. The cost of formula at 3 months of age for one week with a standard formula (not a high cost organic formula or one with special antifussiness pricetags) can be calculated by using a site like babycenter.Formula Calculator or on theKellymom calculator 

Or you can do the math yourself. At about $25-27 for one formula container which should yield about 150 ounces of formula (8.7 grams powder yields one 2 ounce bottle, 657 grams in a container) your 3 month old who is consuming probably 30-40 ounces a day will eat their way through at least 2 of these a week. So in a matter of 1.5 weeks you have paid for at least one consultation by an IBCLC to solve your breastfeeding challenge.

At $50 a week for formula (or probably more) you could have rented at least 3 hospital grade pumps for that month to maintain your supply for a baby who is not latching well. (general cost of hospital grade pump rentals for supply maintenance for the exclusive pumper or full time working mom is between 45-80 a month) .

At $50 a week for formula you could buy multiple packages of lactation cookies by Milkin' Cookies  orMilkmakers .

At $50 a week for formula you could have multiple pill form galactagogues from companies like golacta   or Motherlove .

Second, the cost of healthcare for a formula fed infant with no formula intolerance reaches far beyond the cost of a consult. First one must consider health risk to the infant. Infant's who are not breastfed are at risk for multiple childhood illnesses that include obesity, diabetes, autism, and ear infections to just name a few. Third one must consider the health risk to mom by not breastfeeding. By breastfeeding mom reduces her risk of breast cancer, ovarian cancer, and postpartum depression.  A more indepth list can be found in these articles. Reviews in Obstetrics and Gynecology    and From Canada,   WIC easy to read article and  A great review of the res .

I could also review the risks to mom separately but I think they are laid out pretty well in the articles mentioned above. Overall, I think anyone can clearly see the value in a lactation consultation either prenatally, within a few days postpartum, or when trouble arises. I also think it is pretty clear what the cost of not asking for help or searching out your local breastfeeding resources is both short term and long term to both your wallet, your health, and more importantly your infant's health. Yes, there are some who can not breastfeed whether for physical, anatomica, or psycho-social reasons, but in general almost everyone can make the attempt and have some level of success even if it is only for the first few weeks or months.

Get out, get help, and don't hide behind your front door!! 

Your local IBCLC or La Leche League is waiting for your call and is more than willing to help you overcome your challenges!

For more info in the Las Vegas area please contact Lisa at Breastfeeding and Babies, Yeah! or your local Breastfeeding Coalition or your local La Leche League at llli.org

Thursday, March 28, 2013

CLC, CLE, CLEC, IBCLC....OMG!! What does it all mean?




Let's face it, when you are sitting in your hospital room with a crying, screaming baby and nipple soreness you really don't care who it is who helps, you just want help! It could be from a mom, a dad (who really just wants to fix things), an auntie, a grandma, a friend, a nurse, a doctor, or someone in the lactation field.


If that kind person who helps you in the hospital or in your home is someone in the lactation field it is important that you stare strong and hard at their badge and their bio and find out what their initials are after their name. These initials are not random and like RN, MD, and APN they mean something quite significant in terms of their scope of practice, education background, and standard of practice.

Lactation Field Defined:

CLC: Certified Lactation Counselor
CLE: Certificated Lactation Educator
CLEC: Cerificated Lactation Educator Counselor

IBCLC: Internationally Board Certified Lactation Consultant

What is behind the letters?

CLC, CLE, CLEC:
These courses are NOT Board Certified nor are the Advanced Practice Certifications.

CLC: This is a 5 day class. 45 contact hours for CE provided, from flyer looks like 40-45 hours of classroom instruction, no clinical hours, no attendance at breastfeeding class. From the organization that presents CLC it is important to know that they state, "The CLC certification carries no regulatory authority for licensure. All participants should seek information about how this competency verification certification relates to employment in their community." Taken from webiste: http://www.healthychildren.cc/PDFs/4PageFlyer_2013.pdf

It is also important to note that it also states " The Certified Lactation Counselor® Exam is administered by the Academy of Lactation Policy and Practice (ALPP)" which is a division of Healthy Children Project, Inc. which is the presenter of the CLC and defines the CLC. Here is their pamphlet from 2010: http://www.talpp.org/CLC_Candidate_Handbook_2010S.pdf

CLE: 20 hours instruction time; 4 hours clinicals; Info can be found at: CAPPA; There are also course offerred as 45 CEUs (45 hours) through organizations such as this with no clinical component much like the CLC above. BASTYR Education

CLEC: 45 CEUS offered as: 45-60 hours instruction time; 4 hours clinicals; Info can be found at UCSD Lactation Program


IBCLC, RLC:
These are all Board Certified and Advanced Practice Certifications

IBCLC (often represented as RLC on hospital badge): This is an Internationally Board Certified Lactation Consultant.  Your IBCLC can be an RN, MD, OT, Speech Therapist, Dietician, RT, LPN, La Leche League Leader, or just an interested breastfeeding supporter. Their practice as an IBCLC will be greatly influenced by their other experiences, knowledge, and certifications. Which ever path leads one to be an IBCLC, remember they are an Advanced Practice Clinician and are Board Certified in lactation.

Just like your RN, LPN, RT, or MD passed an exam and stringent qualifications that included schooling and clinical experience, so too did your IBCLC! This person's scope of practice, practice, and licensure is maintained by IBLCE (International Board of Lactation Consultant Examiners) . This person has a license number that you can verify here: http://americas.iblce.org/ibclc-registry.  IBCLC is defined in this document: http://americas.iblce.org/what-is-an-ibclc. Pathways that your IBCLC followed to qualify to take the examination can be found here: Pathways to Becoming an IBCLC and a great video to watch to learn more can be found here: How to Become a Lactation Consultant  .

IBCLCs, like MDs and other healthcare professionals can apply for an NPI (national patient identifier) so that they may join a panel of health professionals and receive payment for services through health insurance.

To complicate matters further:
Now to complicate things further some programs have added more letters to the IBCLC and have intertwined CLC and IBCLC. For instance the use of ANL and ANLC. Over the past few years there has been a fair amount of controversy surrounding CLCs calling themselves consultants and making their practice equivalent to that of an IBCLC. In these courses this melding of the two is done so that an IBCLC and a CLC  can come out with ANL or ANLC at the end of their name.Healthy Children defends their argument in this document: IBCLC and CLC equal? For commentary on this debate you can turn to some fabulous blogs: Public Health Doula ; Anthro Doula ; Lactation Laura

UGH!! Like you weren't already confused, right?

Personally, I just find the creation of this mess of letters by Healthy Children is just one more way to confuse the issue and complicate the pathway for a mom in pain and desperation to find the correct assistance for her breastfeeding challenges.  As you can see from the basic qualifications required for each certification no matter what you put after your name if it is not IBCLC or RLC then you may be interacting with a professional who has had far less exposure and education on the abnormal and incredibly complex issues that can arise when breastfeeding takes a wrong turn. The definitions are also well stated and laid out in this article: http://www.bellaonline.com/articles/art63829.asp.

In the end it comes down to two things. 1. Those of us in the lactation field CORRECTLY representing ourselves and making sure a mom (and we) understands out scope of practice. 2. Moms, dads, partners, aunties, friends, sisters, and those who want to help taking the extra few seconds to ask what a persons qualifications are and quickly checking for an IBCLC certification verification online just as you would for any MD visit. (It's just that important!)




Thursday, March 21, 2013

Preventing the Pump.....HUH??

Yes, the title of this note is Preventing the Pump.

First, why would you want to prevent the pump? Well, let's start with it is not the baby. It is not warm and cuddly and instead is cold and plastic and hard. It is not free and can not be popped on in a park. Instead it is constantly attached to a wall socket and usually used in a closed room separated from family, colleagues, work partners, home partners, and in general a very isolating process. It does not hide the results and it does not feed on demand. Instead it shows how much or how little or how in between your body is on that day at that moment in that time. In doing this it often increases anxiety, the push to make more which causes stress and then in turn decreases your milk production, and makes a mom 'chase the milk trail' as I often put it. And finally it is not free. In order to provide adequate stimulation and emptying of the breast one will need a high powered specifically designed hospital grade pump and there is nothing cute or easily portable about this.

So then, How do you prevent the pump?

Preventing the pump is not something you will see publicized by Gerber or Playtex or Medela or Ameda or EvenFlo or anyone making nipples, bottles, advertisements for your television, or the swing your baby loves. Preventing the pump, like all preventative medicine, is often low profile preventative action that produces high reward for those who search it out. Preventing the pump involves indepth, family specific breastfeeding education. Basically, it involves a plan for feeding your baby.

WHAT? A plan to feed my baby?

Yes, just as you planned your pregnancy and carefully chose those physicians who will take care of you while you grow that beautiful baby inside you there are many who guide you through making plans in conjunction with your wishes, wants, and dreams on how to feed your baby.

This is best done with an IBCLC well versed in the normal pregnancy and the many pregnancy complications like gestational diabetes, high blood pressure, IUGR, preterm birth, and proper management of c-sections for breastfeeding.

With an IBCLC a plan can be made for the perfect birth and then a plan for 'Oh My God What Happened Now? ' situations. A plan should include education on what an appropriate blood sugar is for a breastfeeding baby, appropriate supplementation and when and what should be used if needed, management of jaundice, and skin to skin 'when and where' it should be done. This plan should also include a discussion of pumps and which ones are most appropriate for situations like oversupply at 7-10 days or babies in the NICU or babies who have difficulty with the first latches in the first 7 days or traumatic births.

This plan should also include follow up within 48 hours of birth as well as follow up at 5-7 days postpartum and 2 weeks postpartum as mom and baby build their breastfeeding relationship and grow through the first two milestones of oversupply at 7-10 days postpartum and baby regaining birth weight by 2 weeks of age.

If you plan to prevent the pump then when you need the pump the correct pump will be used.

In preventing the pump you ensure your best chance at a positive breastfeeding experience!
In preventing the pump you ensure the best possible bonding experience with baby!
In preventing the pump you also prevent loss of money on pumps that are not appropriate or damaging to the breast when used inappropriately!

In preventing the pump you will achieve your dreams!

For more information on prenatal lactation consultations and preventing the pump please visit Prevent the Pump!


Best Wishes!
Lisa Weinshenker, RN, IBCLC
A practice of consultation and
sisterhood support for breastfeeding
families.