The Truth about Insurance and Lactation Care

Most of the time breastfeeding does not come naturally, especially for first time moms. When breastfeeding difficulties exist, mothers can experience stress/anxiety/depression. Babies often have weight loss or poor weight gains. Sometimes formula supplementation is started even if it’s not medically necessary, and premature discontinuation of breastfeeding can occur. Although there are free local professional resources and support groups, moms and babies still have persistent gaps in lactation care especially when breastfeeding difficulties are complex.

When problems do arise, it’s hard in today’s tough economic times with skyrocketing health insurance costs to find affordable, high-quality lactation services. Healthcare providers are caught in constraints by insurance companies, Medicaid requirements, and heavy regulatory burdens set by Federal and State governments. Add to that the poor reimbursement rates for lactation care, denial of claims, and delayed payments from insurance companies, and you have a recipe for a system that leaves patients with unmet health needs.

Financial viability for healthcare practices is an everyday concern. The current system has created a situation where providers must see more patients in less time to make ends meet. Because one lactation consult takes 60 to 90 minutes, it’s difficult to reconcile evaluating one mother/baby dyad when 6-8 patients could be seen in the same time frame. This is why lactation support is lacking in the context of primary care and obstetrics offices.

Impacts of the Affordable Care Act

Since the passage of the Affordable Care Act (also known as Obamacare), healthcare spending and costs have been completely out of control. The structure of the ACA has allowed hospitals to buy up private practices, giving them more bargaining power with insurance companies and Medicaid with better reimbursements than primary care providers in small practices. This forces smaller practices out of business, giving fewer choices and less access to care for patients.

Prior to the ACA enactment, 60% of physicians owned their own practices in 2012. In 2022, that percentage fell to 46.7% and continues to decline, according to the American Medical Association. After the ransomware attack on Change Healthcare last year, insurance payments were halted for 6-8 weeks. Many solo and small physician-owned practices went bankrupt.

Better Care Outside the System

After almost 30 years in this business, I wanted to find a better way to help mothers and babies. I decided to open a clinic specifically dedicated to addressing breastfeeding challenges and assisting moms and their spouses to adjust to their new role as parents.

I did not take the decision lightly to move to a cash-based practice versus an insurance-based practice as we are in the midst of some very difficult financial times. But this is the best way to provide a higher level of care that is not possible through the current system.

It is imperative to offer quality comprehensive Lactation Care that allows for dedicated 60-90 minute visits and true individualized care including diagnosis and treatment of maternal or infant medical issues impacting breastfeeding. I coordinate care with your providers.

Through faxed referral treatment notes and immediate phone consults when warranted, your primary provider receives complete written breastfeeding/medical treatment plans. We also schedule 45-60 minutes follow-up visits with you. All services come with complete price transparency. There is no second guessing, surprise bills, or Third Party involvement. Instead, you’ll find simple, transparent pricing, and the care needed for mothers and babies to thrive.

Find a Better Solution

Arrange a FREE 30-MINUTE MEET AND GREET with me so we can discuss your situation, how to make your insurance work for you. You’ll also receive information about Health Savings Accounts with High Deductible Insurance Plans so you can take more control of your healthcare needs.

If you have Medicaid and are struggling with financial difficulties, I have options for you too. Don’t assume you can’t afford such services. My experience will help you find solutions.

Gift certificates are also available for those of you who are grandparents or other family members who want to help someone struggling with breastfeeding and financial hardship. What better way to support those you love and provide the ultimate gift of ensuring the health of moms and babies?

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