66 | Emotional Side of Taking Insurance
Annie: Well, hey there, Leah.
Leah: Annie, how are you today?
Annie: Well, I'm feeling super emotional because we're talking about insurance,
Leah: My heart starts pounding at just the word insurance on so many levels I can totally relate to us feeling emotional because I feel like recently I have felt a lot of emotion around insurance.
Annie: It's been quite a year for one of the in-network companies and a whole bunch of letters that a whole bunch of us got asking for a whole bunch of money back and that's terrifying.
Leah: I know, it's just been so crazy just the whole journey being a lactation consultant and in the beginning, insurance wasn't even really on my mind. Now as I've tiptoed more and more into it, it's like, what have I taken on? Not only have I taken on like, Oh hey, wait for my clients to get their visits covered, which is great, but also this whole giant emotional toll. I think it just there's so many pieces to it that make it even more than just a business decision to take on insurance. Wouldn't you say?
Annie: Yeah, definitely. I mean starting with the fact that there are 11,000 billion trillion codes in that manual, which I know because I've purchased it, and I've combed through it. There's only one that's for lactation. Just one code to rule them all. It's the most general catch-all code. For me being in-network, it pays less, by the way, I just always have to remind this, everybody else in the country gets paid more for that code than those of us who are in New York City, by a billing company that takes us all in-network. It's kind of wild. I'm like, I thought it costs more to live here than elsewhere but okay, maybe not. Maybe I'm wrong.
Leah: Maybe the fact that not even all insurance companies even recognize us as somebody who could provide a service, which is just so frustrating. I have clients who messaged me all the time like my insurance company says that you're not a person that can provide any service, They don't recognize you. How can I help these people get their services covered if I can't even be recognized as a provider or be in-network? I tell my clients all the time like literally, the only reason this isn't covered is because they won't allow me to be in-network with you. They do not recognize me as someone who can be in-network.
Annie: Which is bananas because the other care providers, the pediatricians, the OBs, and the midwives don't have time for lactation clients. They're busy. They're trying to take care of sick people and help people have their babies. If that's the provider they're talking about that you have to be an MD like show me that MD. Show me that specialty. Show me that group of people that is dedicated themselves to medical level. Oh, guess what? It's IBCLCs? Hmm. Imagine that. It's also having this high level of education, working so hard to achieve this credential as an IBCLC, and then having this uncertainty about whether I'm actually going to get paid for the work that I do. Whether it's a client not booking with me because they can't afford the out-of-pocket. They can't even afford a sliding scale that I'm offering because they know their insurance is never going to reimburse that or wondering if I'll take an insurance client and then randomly they'll just decide not to pay the claim. Then I'm spending time and money to call them and be like, no, we did code it right. This is actually a legit claim. Can you please just pay it the way you pay all the other ones? I gotta get paid. I gotta pay my people. It's really frustrating.
Leah: It is and then it's the whole coding thing. If we only have one code, but then they're like, oh but wait, there's all these other codes that you could potentially use. Sometimes we'll be okay with those and then sometimes we won't be okay with those. I hope you can figure it out but we have no real guidance for you other than here's 50 codes that you could potentially try. I find it so maddening in my head. I just want to run away sometimes and be like, is this really worth it. I don't even know.
Annie: They give us the codes. Then I get an EOBs where I'm like, I literally used the code that you literally said is a lactation consultant code with the literal diagnosis code you told me to use, or the literal service, as you say are covered and you're not paying it. What else do you want me to do?
Leah: Feels like a mind game almost. I don't know it just really can trip with your brain sometimes. Then it just adds to the stress of running a business because you've got to have money coming in because you got to pay yourself, people that might work for you and that's so, so just like such an underlying low level, like always there. That's just so hard.
Annie: I get so worried, too, that even talking about money or any stress around money is going to negatively impact my relationship with my client. This is something we talked about in our last episode about boundaries with high-needs clients, and I broke a boundary. One of my very firm boundaries is I don't get on the phone with clients unless they're angry at me about something that Atena did. Then I will get on the phone with them during my vacation and talk to them for 40 minutes to try to talk them down because they get mad at me. I didn't do it. I'm just the person that didn't get paid. I don't know what to say and then I'm just like, never mind, it's fine. I don't want that to damage where they're going with their breastfeeding relationship. Then I'm like, okay, and then I just feel I didn't get paid.
Leah: Yes, it's so hard. I have that, like, I'm such a hard time even on noninsurance situations, talking about money with clients because it is really hard. I feel like not a lot of professions in the medical world directly, the person that's working with the client is also the one that's going to directly talk to them about the financial side of it. Most other health care providers have somebody else taking that role. It does make it really hard sometimes because you don't want to let it interfere with that client relationship, but oh, my gosh, it can really interfere, when not only are they dealing with breastfeeding struggles, but now they're going to have these financial impacts that they might have not expected. It's just so, so challenging. I mean the only thing that makes me feel somewhat better is like ever since you came on the scene, Annie. This is like props to Annie. I have one, learned so so, so much and I know that you have spent a countless number of hours, probably worth millions of dollars, learning about insurance so that you could share it with us. Then find other people who know a lot about insurance and bring them to the table. That has relieved so much of my stress because whenever I start to panic, I just go back to your book about insurance and I'm like, okay, like, let me read it again, make sure everything's okay. It really can, oh my gosh, you just feel like there's no resources for us. So I cannot even tell you how grateful I am for all the hard work that you've done. You deserve some kind of award or medal for that. I'm excited for us because we keep trying to reach out to people who we know know a lot about insurance and try to bring them to the table for you guys so that you guys won't be in the same emotional turmoil, which I'm sure we all are but we're trying to pull us out of it.
Annie: Well, I'm one of those people that I have found super amazing about insurance is Rebecca Costello. So, anybody that did that lactation private practice essential course last spring, it had insurance add on so we had Donna Cena who cowrote the crash course with me, she taught the learning portion of it. Then Rebecca and I did what was supposed to be only a one-hour hot topic and lactation insurance. That ended up being two hours of us just talking about insurance. Then when it was over, we're like, okay, I guess we could wrap up now and people were still there by the way. We ended the Zoom, we're like, okay, bye everybody. Then talk for another 20 minutes about insurance. So Rebecca is good people. She and I are developing a different kind of insurance course later this year that's going to have a lot of self-study in it, a lot of implementation. So that's why I'm really excited she's coming on this deeper dive with us where we're gonna really get to hear from her about all the things. She really brings not just like the wonky, like here's what this code means, the kind of math of it, but she has a really big picture view about how these insurance, emotional aspects of it affect things like Medicaid and equitable care and sliding scale and working with physicians offices and all these kind of pathways that we can see towards making lactation care more accessible and more affordable. She really is thinking a lot about that big picture and the kind of change that really does feel so daunting. Kind of like, oh well, if we just overhaul the whole entire system then maybe it'll be great. There's also chipping away at it one piece at a time and making a difference. What can you do in your community to leverage what the system can do for you and avoid some of those pitfalls that can bring you down or really cause trouble for clients too?
Leah: I cannot wait. I'm always so interested in how we can make some kind of change other than just feeling like, okay, we're stuck with the way that it is. But understanding how we might be able to make change and in all these areas, I can't wait to hear more about it. I'm so excited about our deeper dive with her. I'm, like, waiting, is it today? Come on, it's not.
Annie: I'm excited. We're going to have the link in the show notes and we'll put the link to the previous insurance course too if you're interested in a few quick SERPs about insurance and hearing me and Rebecca go on and on for two hours, but we'll have that deeper dive. If you're listening to this, and the deeper dives already passed, guess what, you can buy the recording. So it's the Eternal Sunshine of the Spotless Mind of insurance. It's just always surrounding you. I don't even know what that metaphor means but sometimes when I think about insurance I really just wish I could erase my brain and forget everything I ever know about it.
Leah: I know well, you've dedicated a lot of time to it so please don't erase your brain. Let's just try to move out of this emotional space. If we can take more ownership in change and feeling like we're not just at the mercy of it all by learning and understanding it better I know that's where we're gonna see more and more shift. I hope to see you guys all there, everyone that's listening you will benefit from being on this deeper dive with us and really learning more. We're going to touch on these emotional aspects but also the nitty-gritty of it as well. So we really look forward to having you guys there.
Annie: We can't wait. Until next time, bye, Leah.
Leah: Bye Annie.