Rule #1: Feed The Baby!

Learning to supplement at the breast.

Breastfeeding. It’s what I’m all about as a lactation consultant. I have built an entire career around helping you to breastfeed your baby. Part of the reason that lactation consultants even exist is that our culture didn’t always place such a high value on breastfeeding. But now it seems like the pressure to avoid formula is everywhere. In fact sometimes it seems that everyone around you is concerned about whether or not your baby gets your precious milk. Continue reading

Filing a Claim with your Insurance

INSTRUCTIONS for PATIENTS FILING FOR REIMBURSEMENT

You are encouraged to file a claim for third party reimbursement. By filing a claim, you may receive partial or full reimbursement and you help to establish the need for reimbursement of lactation services. You may find it helpful to contact your insurance company first. Some companies have specific forms that they require you to fill out when filing a claim on your own and most companies have a filing time limit.

1. Make at least one copy of the blank form (the superbill you were given at your consultation) —before you fill out the patient information on the top. This will ensure that you have another copy in case you have to appeal, or the insurance company loses the form or if you want to re-send with different patient information. (parent vs baby) It is your responsibility to keep track of this form. Duplicates will incur a charge of $10.00.

2. Complete the upper part (Patient Information portion) of the lactation visit receipt and sign the release of information on the right side directly under the Patient Information section. Be sure that the patient matches the diagnosis code. For example, if the diagnosis is “newborn sucking problem,” the patient is the baby. Some companies will reject claims for babies and some for parents. If you’ve made another copy you can file the claim a different way.

3. Parents should mail a copy of the lactation visit receipt with any other forms their insurance company may require to their insurance company. Include a note that you don’t expect to be reimbursed for mileage or other expenses on the super bill (such as nipples shields, etc). Insurance companies often “kick out” a claim because of other fees.

4. Please be sure to keep a copy of your lactation visit receipt, claim forms, referral scripts, etc. for your records and mark on your calendar when the claim was mailed in.

5. If, after 60 days, you have not heard from your insurance company, call them to check on the status of the claim. If you have not heard anything for 60-90 days, you may want to write a letter to your insurance commissioner in your state and send a copy to the insurance company.

6. The top reasons that claims are denied are because it’s not a covered service or the lactation consultant is not a provider on your plan. If it is because the lactation consultant is not a provider on your plan, ask who the lactation consultant provider is. Most likely they will say that they do not have a lactation consultant provider on their plan. Then, you reply that you had a referral to be seen by this lactation consultant by your physician because you were experiencing such and such a problem. Tell them that the American Academy of Pediatrics recommends that all babies be breastfed for one year and that the AAP recommends mothers and babies be seen by a board certified lactation consultant when breastfeeding difficulties occur. The AAP also recommends that third party insurance reimbursement be made for lactation help.

7. The Affordable Care Act mandates insurance coverage for lactation services. This is the law. It also mandates no co-pays or deductible for lactation services. Know your rights! This post will give you more information about how to talk to your insurance company about this.

8. Don’t stop with NO from the first person you speak to. Request to speak to their supervisor. The squeaky wheel is the wheel that gets oiled. If you want reimbursement, you may have to fight for it. This is how many things that are now covered by third party insurance companies have come to be standard reimbursement.

A formal appeal may be necessary for you to get reimbursed. You will find a sample letter of appeal on my website.  There is also a link there for the Washington State Insurance Commissioner. If you have been denied reimbursement for lactation services, he wants to know about it!

Updated: Video Consultations: How do They Work?

The family in this video “met” with me from two different countries. This is the last few minutes of a consultation. The client is talking about meeting with a local IBCLC for follow up to our meeting.

I can do a virtual consultation with you no matter where you are on the planet! We are not limited by long-distance fees—only by time zones and a decent internet connection.

Ideally every breastfeeding parent and infant would have access to high-quality in-person lactation care. The reality is that many people do not have this available in their communities. Virtual consultations are just like in-person consultations except we’re not actually in the same room. They are appropriate for any type of breastfeeding challenges you may have including, latching difficulties, questions about tongue mobility, frenotomy care, sore nipples, milk supply or pumping difficulties. These consultations are not recorded. Continue reading

Frenotomy–Parent Perseverance Pays Off

20140828_095301Breastfeeding always hurt for first- time breastfeeder, Tina. She was given a nipple shield to help with the pain. And it did help. Even so, she knew a nipple shield was not a long-term solution. She kept trying to get rid of the shield. She hated the thing! But every time baby latched without it it, it resulted in intense nipple pain and wounds—her nipple was painfully creased after feedings as well. So, understandably,  she continued to nurse with the shield.

Meanwhile, baby Carolyn wasn’t gaining weight well. At every appointment she was gaining about ½ of expected weight gain. Baby was breastfeeding frequently—over 10x/day and still not gaining appropriately. She was having infrequent bowel movements, was gassy, and uncomfortable. Tina felt that something was very wrong. Continue reading

Frenotomy Aftercare: Effective and Respectful

Your baby has had a frenotomy/frenectomy (frenectomy is the term for laser frenulum release and frenotomy for scissors) and the last thing you want is for it to heal incorrectly–possibly requiring a second procedure.  You probably got a handout with instructions for aftercare. It sounded simple when your IBCLC was discussing it with you.  But now that you’re home with baby, it all seems so confusing. What are all these “stretches” and “exercises” people are talking about?

Your provider might call them “stretches,” or “sweeps” or “exercises”. Whatever they are called, there is one purpose–to ensure that the frenotomy site heals as open as possible; which, in turn, will give baby more mobility (movement) of his tongue. We want that beautiful diamond that was created with the frenotomy or frenectomy to stay a beautiful diamond. Just like the one below.

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This photo was taken just a few days after a laser frenectomy. The color of the diamond is normal. It will be white or yellowish for a few days before it fades to pink.

 

 

 

 

Doing effective aftercare means you have to get your fingers in your baby’s mouth.  You’re not used to it. It feels strange. And baby likely won’t be thrilled about it either. Keep in mind, however, that there are probably a lot of things that your baby objects to, but you do it anyway, right? You change her diapers, bathe her and put clothes on her–all with some degree of protest from baby.

A few pointers to make this easier for both you and baby. Ask permission–verbally or by gently tapping on mouth with your fingers. Be matter-of-fact about the process and let baby know what you’re doing. Keep it short. Lastly, no need to be rough–you can be gentle and still be effective.

Here’s a short video of a tongue tied baby who is graciously helping to demonstrate aftercare. Most babies–including this one–really dislike anything under the tongue. She lets us know that she is not happy about the “forklift” maneuver, but she is not in any pain. Note: This is before the frenectomy so the frenulum is still present.

 

 

The photo below shows the forklift maneuver from the perspective of the parent. Note that the IBCLC in the picture is approaching from the top of the baby’s head. This is the most effective way to get complete separation of tongue and the floor of the mouth. The middle fingers are holding the chin to get separation–not merely a lift of the tongue. If you only lift the tongue, the jaw will follow and separation will not occur.

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Gloves are not required if you are the baby’s parent! But some parents do use gloves to do the aftercare because of concerns about fingernails. It’s up to you. Do whatever works for you to ensure that these “exercises” happen at least 6 times per day.

Finally, whether laser or scissors, please schedule a follow up with your IBCLC and your frenotomy/frenectomy provider about 5-7 days post procedure. You and your baby will benefit most from the procedure with timely follow up.

See also: “My Baby is Tongue Tied?”, “Twenty Things You Don’t Know about Tongue Tie”

If you suspect that your baby is tongue tied, I’m happy to help! No matter where you are around the globe, virtual consultations are available. If you’re in the Seattle area, we can meet in your home or at Docere Center for Natural Medicine.

For frenotomies in the Seattle area I highly recommend Dr. Chenelle Roberts at Docere Center for Natural Medicine in the Greenlake neighborhood.