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USLCA Efforts for Licensing and Insurance Credentialing

UNDERSTANDING THE BASICS 

          Affordable Care Act-upheld in 2012 mandates that eligible private health insurance maternity policies rolling over after August 1, 2012 must begin covering preventative health services, including lactation care, without cost-sharing or co-pays from members.

          Women's Preventative Services Package in the Affordable Care Act-specific language of the Affordable Care Act that lactation care delivery.

          Center for Medicare & Medicaid Services: Medicaid Coverage of Lactation Care Services-Although this document develops the language for the Affordable Care Act's inclusion of breastfeeding care, it does not name the IBCLC as the gold standard as the lactation care provider.*

          Surgeon General's Call to Action to Support Breastfeeding-This specifically mentions the IBCLC as the gold-standard provider in lactation and breastfeeding care.**

*The fact that the IBCLC was not mentioned as the gold-standard deliverer of lactation care for Medicaid is the major loophole that affects the IBCLC credentialing effort. Medicaid, thus far, pays for services by licensed providers; most IBCLCs are not licensed. What this means is that other licensed providers (dieticians, pediatricians, obstetricians, etc.) will be able to bill for lactation codes since they are licensed (regardless of their specialty, and regardless of whether or not they are IBCLCs) if any level of breastfeeding education was provided.

**The Surgeon General's Call to Action to Support Breastfeeding DOES mention IBCLCs as the gold-standard provider in lactation and breastfeeding care. The efforts of the USLCA focus on linking this federal 'edict' with the Affordable Care Act implementation. 

           Containing Healthcare Costs in Plain Sight-USLCA publication which breaks down the cost-effectiveness of IBCLC credentialing for health insurance companies and private physician practices. THIS IS AN EXCEPTIONAL RESOURCE.

KEEP IN MIND

Medicaid and private health insurance companies have separate policies about credentialing. Whereas Medicaid cannot currently credential non-licensed providers, private health insurance companies can credential whatever speciality they feel meets the needs of their member and AND the company's bottomline. Using USLCA's "Containing Healthcare Costs in Plain Sight" is an EXCELLENT tool to provide private health insurance companies and private physicians as to how exactly IBCLC credentialing will reduce illness, save money and attract members to their organizations.

Medicaid does, however, contract with some private health insurance companies in some states. Medicaid members choosing to use a Medicaid contracted private health insurance company in these states can receive access to IBCLC care if the private health insurance Medicaid has partnered with providers coverage of the non-licensed IBCLC.

USLCA Must-Reads

           USLCA Licensing & Reimbursement Committee Website-***Please visit every link on this page to help you get a thorough understanding of the efforts, and the processes IBCLCs are and will encounter during the general health insurance credentialing efforts, and specifically with Aetna.
                   
           USBC Summary of Licensing and Reimburesment

BECOME AN INSURANCE COMPANY PROVIDER (can take 30-60 days and sometimes longer)

Aetna, so far, is the only national health insurance provider who has started credentialing all IBCLCs. States such as Nebraska, have statewide private insurance companies who have begun the credentialing process. As others become available in Texas, I will update this site.

Getting Started with Aetna:

          1. USLCA Q & A from Aetna Credentialing Conference Call

          2. Obtain National Provider Identification Number (NPI)*

          3. Join Aetna's Network

          4. CAQH Website (Register with the Unified Provider Datasource)*

* Items 1 & 4 are essential steps to take to apply for credentialing with any health insurance company. These are the two longest steps and won't need to be repeated with each application to a new health insurance company. CAQH applications are to be updated every 120 days.

FUTURE DELIVERY of LACTATION SERVICES

When IBCLCs become routinely credentialed by health insurance companies, delivery of lactation care will shift. Whereas presently, lactation services are mainly provided by healthcare systems as a 'charity' item, hospital systems will begin to see breastfeeding care as profitable.

These are some of the changes hospital IBCLCs may see:

-An expansion in their hospital's lactation program
-IBCLCs potentially negotiating higher salaries
-IBCLCs potentially joining health systems as individual providers, as in having "priviledges" vs. direct employment
-Motivation from health system administrations to strengthen policies against unncessary artificial baby milk use (since this could be perceived as a "conflicts of interest")

GET INVOLVED

Reach out to our elected officials and introduce them to the IBCLC's plight!

Texas State Representatives
              Search by Zip Code: Who represents me?

Congressional Districts
Districts 15, 20, 21, 23, 25 & 28

How can San Antonio elected officials help?

Share "Containing Costs In Plain Sight" with them and help them bring this to the attention of our city's health insurance companies! They CAN help us develop a market in San Antoni. With the

SAN ANTONIO IS INTERESTED IN HEALTH!

Link local preventative health with economics!

Involve SA Metropolitan Health District

Read about SA's health initiatives

San Antonio Mayor's Office

San Antonio Office of Economic Development    


CONTACT THE HEALTH INSURANCE COMPANIES

Sample Letter-waiting for permission to use

America's Health Insurance Plans-major American health insurance trade organization

Health insurance companies in Texas-Search by name

BENEFITS TO PEDIATRIC OFFICES

Creating an Office Setting that Promotes and Support Breastfeeding-Excellent! From the Pennsylvania Medical Society

Good blog about what having an IBCLC in their office could do for a pediatrician












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Breastfeeding Housecalls & Lactation Clinic, LLC
(210) 209-1002
San Antonio, TX

The services offered by Breastfeeding Housecalls do not replace medical advice;
please consult your healthcare provider if you suspect you or your child are not well.


As does every healthcare provider, Breastfeeding Housecalls has a legal obligation to report unsafe conditions.



Our Affliations
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Breastfeeding Housecalls adheres firmly to the World Health Organization's Code of Marketing of Breastmilk Substitutes and only participates in activities or conducts business with organizations who are free of ties from manufacturers of artificial baby milk (infant formula).

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Breastfeeding Housecalls & Lactation Clinic LLC


Breastfeeding Housecalls will take legal action against any person, company or organization who/that takes or uses as theirs any content or original concept from this website.

Breastfeeding Housecalls, LLC's ​Privacy Practices
  • Scheduling
  • About
  • Online Breastfeeding Class
  • Common Breastfeeding Issues
    • Engorgement
    • Sore Nipples
    • Latch
    • Milk Supply
    • Pumping Class
    • How do I choose the right doctor for my baby?
  • Breastfeeding TeleHealth
  • Prenatal Breastfeeding Prep
    • San Antonio Doulas
    • Post Partum Depression
    • Breastfeeding Resources in San Antonio
    • Breastmilk Donation
  • Tongue Tie
  • BreastReading Blog
  • Breastfeeding Education for Business
  • En español
  • Contact Us
  • Testimonials
  • Media, Advocacy and Special Programs
  • Breastfeeding Support Groups
  • Equity & Diversity Resource Page
  • Tongue-Tie-Learning-Center
  • For Professionals
  • Baby Scale Rental
  • Formula Shortage
  • Feeding-Emergency
  • Insurance Verification