Reimbursement

In most countries lactation services are a part of the national health care system and reimbursement for these services is mainly through salaried positions paid for by government programs. In the United States, reimbursement for lactation services is extremely complex and depends upon the setting where the services are provided, educational qualifications of the provider, and the type of insurance involved.

LCs who work in a birthing center, hospital, or medical office are usually salaried employees reimbursed with a set hourly or weekly wage. Hospitals usually include LC services as part of the total cost of the maternity "package." The cost package is an agreement between the insurance company and the hospital to charge a certain amount of money for health-care coverage for each birth. This is known as capitation. Managed care companies compete with each other with price bids to win the health care contract, the lowest bid gaining the contract.

If postpartum home visits are part of a maternity insurance package, breastfeeding assistance is given as a part of a routine postpartum visit to the mother's home. Nurses providing these home visits are usually salaried by the home health company that employs them. Services above and beyond the packaged LC services are paid for either by a separate insurance claim or by the family themselves.

For the LC in private practice, cash payment for services rendered or for equipment is usually requested from the client at the time of the service. The client in turn seeks reimbursement from her insurance company and provides the third-party payer with the information it needs. The client may give the LC forms to complete and send to the insurer in the hope of being reimbursed. Insurance companies expect to be sent the HCFA form that can be downloaded from www.medela.com. A "Superbill" with ICD-9 codes is displayed in Box 2-7. This form, along with an instruction booklet, is available from Pat Lindsey, IBCLC, at www.patlc.com.

Insurance and Third-Party Payment

Insurance and third-party payment for lactation services is a complex issue. Third-party payment—insurance or payment by another entity besides the patient—varies according to the state (and country) where the services were given. In the United States, third-party payers can be divided into two general categories: government or public health insurance

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Pregnancy And Childbirth

Pregnancy And Childbirth

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