Payment for breastfeeding clinical services is inconsistent and sporadic. Breastfeeding involves mostly primary prevention, and as such attracts less attention and funding than do dramatic curative procedures, drugs, or technology. Lack of reimbursement may partially account for the poor training and meager motivation by health care providers to offer current and appropriate breastfeeding care and services. Scarcity of population-based cost-effectiveness studies of breastfeeding outcomes on which policy-makers and third party payers rely, further hamper provider reimbursement. Failure of health payers to accept the potential and real cost savings of breastfeeding to the healthcare system presents another barrier to those seeking payment for breastfeeding support services. The explosive growth in medical expenditures plus the short-sightedness of cost containment efforts, channel reimbursement funds to preventable conditions and diseases, remove those qualified to provide appropriate care, and contribute to the nation's poor exclusive breastfeeding initiation and duration rates. Given this situation, how can providers secure reimbursement for the lactation services they provide to families? This presentation will explore who offers these services, what they entail, where they are obtained, who uses them, what they cost, the potential cost of not providing the lactation services, who is getting reimbursed, who is reimbursing, and how to get reimbursed. At this writing, the American Academy of Pediatrics has submitted an application to the American Medical Association for a new CPT ocde for lactation counseling. Should this be accepted, it will be incorporated into the discussion.
Learning Objectives: Participants will be able to: 1. discuss barriers to reimbursement for breastfeeding care and services 2. describe mechanisms for various health care providers to currently secure third party reimbursement for breastfeeding care and services 3. state the parameters of a new CPT code for lactation counseling should it be accepted by the American Medical Association
Keywords: Breast Feeding, Insurance-Related Barriers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.