Archive for June, 2010

Insurance Reimbursement Appeal Letter Sample

June 30, 2010

This letter is my formal appeal of the rejection of Claim Number _____ for Lactation Consultation Services provided to my son, (Name) on (Date) for the amount of _____.

Summary of Events: Child was born on (Date). He was discharged from the hospital on (Date) (Detail here whatever complications you had with feeding/jaundice/dehydration/re-admittance to hospital, etc) On (Date) we met with our pediatrician, (Name) and expressed concerns about breastfeeding. Dr. _______ noted that baby was struggling to thrive and referred us to Lactation Consultant, Renee Beebe, M.Ed., IBCLC. Renee provided her services on (Date). Following the consultation, I submitted all required paperwork to (name of insurance company) for reimbursement. On (Date), I received an Explanation of Benefits (referenced above), noting the claim was denied.

Call to Customer Support: On April 23rd, I called the Insurance Company customer service line with questions regarding the Explanation of Benefits dated (Date). The CSR stated that Lactation Consultations are covered by our plan under two scenarios; (a) when under hospitalization following birth or (b) if the infant is “Struggling to Thrive” and that (baby’s name) had not met either of these criteria. Additionally, the CSR also explained that even if he was eligible for the benefit, the Lactation Consultant we used is not an “In Network” provided. I informed the CSR that it is not possible to identify an “In Network” Lactation Consultant using the Insurance Company online search tool. She reviewed the tool and confirmed.

Basis of Appeal: Based on (Baby’s name) medical history and our pediatrician’s observation, (Baby’s name) was “Struggling to Thrive,” which means we met the criteria for coverage under our plan. Additionally, the question of “In Network” vs. “Out of Network” is irrelevant since it’s not actually possible to locate an “In Network” Lactation Consultant using the (Insurance Company) system. Because we could not locate a provider using the (Insurance Company) system, we used Renee Beebe, the Lactation Consultant recommended by our Pediatrician. Renee is certified by the International Board of Lactation Consultant Examiners (IBLCE), which is the recognized association in the field. If a service is covered by our plan, it’s only fair that we can have it preformed. In this case, (name of insurance company) has made that unreasonably burdensome to locate a provider, so one was selected based on the Pediatrician’s recommendation.

Additional Information: The American Academy of Pediatrics recommends that all babies be breastfed for at least one year. Additionally, 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 reimbursements be made for lactation help.

Thank you to the parents who provided this sample letter so that other parents may be reimbursed for lactation services.  All of my clients receive an insurance claim form and are encouraged to file a claim with their insurance company.  Many insurance companies are now covering my consultations.  If a claim is denied, appeals are often successful.  In the state of Washington, you may also file a complaint with the insurance commissioner, http://www.insurance.wa.gov/consumers/ For more information, contact Renee Beebe, M.Ed., IBCLC.

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Community and Internet Resources

June 28, 2010

www.nestinginstincts.org Comprehensive care from pregnancy through breastfeeding.  Classes, doulas, lactation consultations and placenta encapsulation.  Seattle area.

www.milk-makers.com Delicious cookies that help boost milk supply.  Sign up for informative, monthly newsletter.

www.pollywogbaby.com Information and products for infant reflux and GERD.  Free downloadable parent handout.

www.hadleystilwell.com Beautifully tailored clothing for working, breastfeeding and pumping.

www.fertilefoods.com Resource for fertility issues, pregnancy, breastfeeding and overall nutrition.

www.zoelotus.org, www.rubymoonwellness.com Acupuncture and massage for fertility, pregnancy, breastfeeding and beyond.  Seattle area.

www.soundgardenhealing.com Acupuncture specializing in fertility issues.

Bella Materna, comfortable and supportive  bras, panties, camisoles and more for pregnancy, breastfeeding and beyond.

Seattle area birth doulas:

Jan Martinka: www.janmartinka.com

Joy MacTavish: www.sounddoula.com

Down to Earth Doulas: www.downtoearthdoulas.com.  se habla espanol.

Serene Doulas: www.serenedoulas.com A team of 3 doulas providing comprehensive care.

My Baby Has Reflux!

June 28, 2010

“My pediatrician says my baby has reflux! She says there are medications to help. I really don’t want my baby to take medicine. He’s so little. But I also don’t want him to suffer and spit up so much. What should I do? Can you help me?”

Although the diagnosis of reflux seems ominous, keep in mind that all babies have reflux to some degree. The sphincter muscle that separates the stomach and the esophagus is loose and lets fluids go back and forth. That’s why it’s common for babies to spit up after a meal. If your baby seems uncomfortable, however, he may need some help.

I see many babies diagnosed with reflux in my practice. I have found that some simple changes in feeding posture or management can decrease symptoms substantially. Most of my clients do not need to medicate their babies.

If your baby is squirmy, uncomfortable and excessively “spitty” during or after feeds, he may simply be eating too much or too quickly. Do you have an over-abundant milk supply? Does your baby struggle to “keep up” when breastfeeding? Is he gaining weight rapidly?

  • Give your baby frequent burping breaks.
  • Offer baby just one breast per feeding.
  • Position your baby at an incline so that his trunk is higher than his hips and his spine is straight. Try the Pollywog Nursing Positioner at www.pollywogbaby.com.
  • Try breastfeeding lying down on your side with baby beside you.

If your baby has green, frothy stools in addition to discomfort, he may be struggling with a foremilk/hindmilk imbalance. This is usually corrected easily by offering just one breast per feeding. Be sure to check with your pediatrician or lactation consultant to ensure your baby is is gaining weight properly before making any changes to your feeding routine.

For assistance with breastfeeding management, contact Renee Beebe at www.second9months.com.

See also, Is My Baby Getting Enough Milk?


For more information on infant reflux, including helpful products, please see www.pollywogbaby.com.




A Perfect Latch

June 21, 2010

Perfect Latch in Football Hold

Here is a beautiful example of a football hold latch. This baby is just 5 days old, but he knows exactly what to do!

How do we know this latch is perfect?

His nose is tilted away from mom’s breast.

His chin is tucked in firmly to the underside of the breast.

Baby’s top lip barely covers mom’s nipple.  Baby’s mouth is assymetrical in relation to mom’s areola. The areola is clearly visible above the top lip but the lower part is covered by baby’s mouth.  (Note:  The appearance of the latch will differ slightly with each mom due to anatomical variations.)

Baby’s mouth is open wide.  The corners of his lips are not touching.

Most importantly, baby is drinking and mother is comfortable!  Click here to see this baby in action and hear the swallows!

Claire’s Breastfeeding Story

June 14, 2010

The mother in the video contacted me when her baby was 5 weeks old. Her first week of breastfeeding resulted in cracked, bleeding nipples and a bacterial infection. Her nipples were so sore, she had to stop breastfeeding. She did, however, pump regularly to preserve her milk supply. Breastfeeding was important to Claire. She had fond memories of nursing her first daughter. She desperately wanted to nurse this new baby as well; but was afraid to try again.

Claire told me her story and asked for help to breastfeed her newborn daughter without pain. She was concerned that, after 4 weeks of bottle-feeding, her baby may not want to breastfeed. She was also concerned about her milk supply—she was not able to “keep up” with her baby—needing to supplement with some formula each day.

Needless to say, Claire was nervous about trying breastfeeding again. The memories of that first week of pain were still vivid. We worked on getting the latch just right—making sure baby’s mouth was open wide enough. Claire had lots of guided practice to help her baby latch deeply onto the breast well behind the nipple. Her baby daughter was happy to cooperate.

To view a video clip of one of Claire’s practice sessions, click here. But first, read on for a brief description of what you will see.

As you watch the clip, notice the position of the baby relative to Claire’s breast. The baby is slightly under the breast and her upper lip is lined up with the nipple. When baby opens wide, Claire quickly brings the baby all the way to the breast. Baby’s top lip barely covers the nipple. In her effort to help her baby to latch deeply enough, she goes just a bit too far, but she adjusts her baby’s position accordingly when she knows the latch feels right.

Claire generously provided this video in hopes of helping other breastfeeding mothers. She and her infant daughter are now a happy breastfeeding couple. Her milk supply increased when she started breastfeeding again and her baby is thriving without supplements.

See also, “Cross Cradle Latch with Claire” for video.

Cross Cradle Latch with Claire

June 14, 2010

Notice the position of the baby relative to mom’s breast.  The baby is slightly under the breast and her top lip is aligned with the nipple. Mom waits for the baby to open wide.  When latched correctly, baby’s top lip barely covers the nipple.   See “Claire’s Story” for more detail about this video clip.

Never Wake a Sleeping Baby?

June 9, 2010

Newborn sleeping

Breastfeeding seemed to go OK at first. After all, the baby was nursing a lot and slept well. It didn’t seem right to the new mom that her 1-week-old baby slept 6-8 hour stretches, but everyone said “don’t worry.” A pediatric visit at 2 weeks confirmed this mom’s worst fears. Her baby had lost weight!  She was told to supplement with formula and contact a lactation consultant.

I met with this mom a few days later. She explained to me that her nipples had been cracked and bleeding from day 1. Baby was fussy after feedings but slept for hours with the help of a pacifier. Since the baby slept so much, she thought he was getting enough milk.

At first glance, the baby appeared to be eating well, but there were early warning signs. Sore nipples indicated a poor latch. The baby was often at the breast for an hour at a time and not satisfied after feedings. His urine was concentrated and poopy diapers were rare.

So, when do you wake a sleeping baby? In the first few weeks the baby must eat at least 8 times per day. Your baby will pee and poop multiple times per day and will be content and sleepy after feedings. If you’re unsure if your baby is breastfeeding well, schedule a visit with your pediatrician or lactation consultant to weigh the baby. Once you know your baby is thriving and all is going well, you can relax a little, and trust that your baby will tell you when it’s time to eat!


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