Re: sliding scale payments

[Guest guest]

Patrice wrote:

I am wondering how people who use a sliding scale fee work this??? Most of the clients referred don't seem to mind or have a problem paying but there is a whole community of people out there who don't have the means and they don't get referred for help at times. Yes, I know - LLL is there for them and that's great!!! Anyway, if anyone has any thoughts on how they handle referrals who don't have the means to pay.

Hello, Patrice.

I also wondered about this when I first opened my private practice years ago. I talked with staff at the local Health Departments and WIC (Women, Infant, Children program in the USA, to provide food for children under the age of 5 years and mothers for some months after a baby's birth) offices and asked about their sliding scales. While they were willing to share with me what income level qualified for their services, I also learned that the amount changes almost every year.

I decided I didn't want to know what people earn, and didn't want to be in the position of deciding who makes so little to qualify for reduced rates. And I didn't want the headaches of changing the scale every year as the government does. So, I figured people who qualify for WIC and Medicaid (public health insurance in the USA) have already told those agencies what their income is, had it verified, and didn't need the embarrassment of telling yet another person (me) how much money they make. I decided to use that as my qualifier. Any woman who qualifies for WIC or Medicaid and **can show me an appointment card or other official means to verify it**, I only charge half-price for my consultation fee. While I realize that some women can't even afford half my fee (and I have a very low, very reasonable fee to begin with), I just can't do this for free. There are WIC Peer Counselors who can try to help,

and will refer to me if they just don't know what to do for a mother. There are also LLL Leaders in my area, some of whom will make home visits, but again will refer to me if they can see the situation requires more knowledge than they have. So there is free help available. And quite a few women who qualify for the public aid have access to the internet and can read a lot of information and watch breastfeeding videos over the internet. So, while I regret I can't help every woman, I do have a business to run and can't give everything away. I do require the mother to show me proof of eligibility for the public services, because I have had women tell me over the phone, "Oh yes, I'm eligible, I just haven't applied yet". I tell them to apply and let me know what they find out. Then when they come to the consultation (I only do in-office visits, with payment at time of service) and I ask if they qualify for WIC,

they say that no, they didn't qualify. While some may have honestly thought they did, but didn't, I also know positively that some women will try to get by for less by dishonest means. So I require proof, but I let the government agencies determine who needs financial help.

Dee Kassing

[Guest guest]

we offer sliding scale AND we have a grant through Nursing Mothers' Counsel to pay (at a discounted rate) for low income mothers to receive services. We take mothers at their word that they are low income and can't afford services - I have found that mothers usually try to pay something even if they really can't afford it, and i have not had many (if any) experiences of mothers trying to "work the system" to get free services.

we tell families who want to utilize the grant that if they can afford to pay anything, it helps provide free and sliding scale services to other families - but to please not make finances a barrier to getting the services they need. if someone who calls says they are referred from WIC or Nursing mother's counsel, we either assume they are needing sliding scale/grant, or we ask if they are on WIC or Oregon Health Plan, and if so, offer that option.

we have a statement to that effect on our web site:

"Options for low income families If you are low income, please do not let that be a barrier to getting the services you need. A sliding scale and/or a grant-funded consultation, at no cost to you, may be available to ensure lactation services are accessible to all who need them."

[sPAM] sliding scale payments

I have a home visit private practice lactation consulting business. One of my most frustrating moments is when a client calls wanting help, I explain what I do, home visit for 1/1/2-2 1/2 hours, give them the tools to submit the bill to insurance company, cost of the visit explained and tell them I will be happy to work out a payment plan if necessary. When they don't call back and I can feel it is because of cost - I feel so frustrated. I am wondering how people who use a sliding scale fee work this??? Most of the clients referred don't seem to mind or have a problem paying but there is a whole community of people out there who don't have the means and they don't get referred for help at times. Yes, I know - LLL is there for them and that's great!!! Anyway, if anyone has any thoughts on how they handle referrals who don't have the means to pay. Of course, I have at times done a consult without payment - but as a general rule I can't do this.

[Guest guest]

I tell moms that if they qualify for WIC or are enlisted in the military (or their spouse) that I give a discounted rate.  Whatever works for your population.  I generally find that when they know the full cost vs. the discount they are more willing to pay for a visit.  Also, keep in mind the first rule, "Never work harder than your client."   If they don't call you back then they might not really want the help.  Many moms feel pressured to breastfeed and are looking for permission to quit or not start.  That they can say a visit was too much money seems reasonable to some.  I know this sounds pessimistic but I found that when I did home visits as a volunteer or for minimal fees that we were usually wasting everyone's time.  People generally find a way to pay for what is important to them or to ask for a way to make it happen with a smaller fee.

When I found the right price for a consult and a discount I felt much better about being able to help moms who were willing to pay for the help and not so guilty about the moms who say they want help but never really followed through on what they could have done to have success.

I hope that is helpful in some way.

Christie Pillado, IBCLC

formerly of El Paso, TX and now in Northern VA!

s

liding scale payments

I have a home visit private practice lactation consulting business.

One of my most frustrating moments is when a client calls wanting help,

I explain what I do, home visit for 1/1/2-2 1/2 hours, give them the

tools to submit the bill to insurance company, cost of the visit

explained and tell them I will be happy to work out a payment plan if

necessary. When they don't call back and I can feel it is because of

cost - I feel so frustrated. I am wondering how people who use a

sliding scale fee work this??? Most of the clients referred don't seem

to mind or have a problem paying but there is a whole community of

people out there who don't have the means and they don't get referred

for help at times. Yes, I know - LLL is there for them and that's

great!!! Anyway, if anyone has any thoughts on how they handle

referrals who don't have the means to pay. Of course, I have at times

done a consult without payment - but as a general rule I can't do

this.

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[Guest guest]

> I am wondering how people who use a

> sliding scale fee work this??? Most of the clients referred don't

seem

> to mind or have a problem paying but there is a whole community of

> people out there who don't have the means and they don't get

referred

> for help at times. Yes, I know - LLL is there for them and that's

> great!!! Anyway, if anyone has any thoughts on how they handle

> referrals who don't have the means to pay.

>  

> Hello, Patrice.

>    I also wondered about this when I first opened my private

practice years ago.  I talked with staff at the local Health

Departments and WIC (Women, Infant, Children program in the USA, to

provide food for children under the age of 5 years and mothers for

some months after a baby's birth) offices and asked about their

sliding scales.  While they were willing to share with me what income

level qualified for their services, I also learned that the amount

changes almost every year. 

>    I decided I didn't want to know what people earn, and didn't

want to be in the position of deciding who makes so little to qualify

for reduced rates.  And I didn't want the headaches of changing the

scale every year as the government does.  So, I figured people who

qualify for WIC and Medicaid (public health insurance in the USA)

have already told those agencies what their income is, had it

verified, and didn't need the embarrassment of telling yet another

person (me) how much money they make.  I decided to use that as my

qualifier.  Any woman who qualifies for WIC or Medicaid and **can

show me an appointment card or other official means to verify it**, I

only charge half-price for my consultation fee.  While I realize that

some women can't even afford half my fee (and I have a very low, very

reasonable fee to begin with), I just can't do this for free.  There

are WIC Peer Counselors who can try to help, and will refer to me if

they just don't

> know what to do for a mother.  There are also LLL Leaders in my

area, some of whom will make home visits, but again will refer to me

if they can see the situation requires more knowledge than they

have.  So there is free help available.  And quite a few women who

qualify for the public aid have access to the internet and can read a

lot of information and watch breastfeeding videos over the internet. 

So, while I regret I can't help every woman, I do have a business to

run and can't give everything away.  I do require the mother to show

me proof of eligibility for the public services, because I have had

women tell me over the phone, " Oh yes, I'm eligible, I just haven't

applied yet " .  I tell them to apply and let me know what they find

out.  Then when they come to the consultation (I only do in-office

visits, with payment at time of service) and I ask if they qualify

for WIC, they say that no, they didn't qualify.  While some may have

honestly

> thought they did, but didn't, I also know positively that some

women will try to get by for less by dishonest means.  So I require

proof, but I let the government agencies determine who needs

financial help.

>     Dee Kassing

>

[Guest guest]

> I am wondering how people who use a

> sliding scale fee work this??? Most of the clients referred don't

seem

> to mind or have a problem paying but there is a whole community of

> people out there who don't have the means and they don't get

referred

> for help at times. Yes, I know - LLL is there for them and that's

> great!!! Anyway, if anyone has any thoughts on how they handle

> referrals who don't have the means to pay.

>  

> Hello, Patrice.

>    I also wondered about this when I first opened my private

practice years ago.  I talked with staff at the local Health

Departments and WIC (Women, Infant, Children program in the USA, to

provide food for children under the age of 5 years and mothers for

some months after a baby's birth) offices and asked about their

sliding scales.  While they were willing to share with me what income

level qualified for their services, I also learned that the amount

changes almost every year. 

>    I decided I didn't want to know what people earn, and didn't

want to be in the position of deciding who makes so little to qualify

for reduced rates.  And I didn't want the headaches of changing the

scale every year as the government does.  So, I figured people who

qualify for WIC and Medicaid (public health insurance in the USA)

have already told those agencies what their income is, had it

verified, and didn't need the embarrassment of telling yet another

person (me) how much money they make.  I decided to use that as my

qualifier.  Any woman who qualifies for WIC or Medicaid and **can

show me an appointment card or other official means to verify it**, I

only charge half-price for my consultation fee.  While I realize that

some women can't even afford half my fee (and I have a very low, very

reasonable fee to begin with), I just can't do this for free.  There

are WIC Peer Counselors who can try to help, and will refer to me if

they just don't

> know what to do for a mother.  There are also LLL Leaders in my

area, some of whom will make home visits, but again will refer to me

if they can see the situation requires more knowledge than they

have.  So there is free help available.  And quite a few women who

qualify for the public aid have access to the internet and can read a

lot of information and watch breastfeeding videos over the internet. 

So, while I regret I can't help every woman, I do have a business to

run and can't give everything away.  I do require the mother to show

me proof of eligibility for the public services, because I have had

women tell me over the phone, " Oh yes, I'm eligible, I just haven't

applied yet " .  I tell them to apply and let me know what they find

out.  Then when they come to the consultation (I only do in-office

visits, with payment at time of service) and I ask if they qualify

for WIC, they say that no, they didn't qualify.  While some may have

honestly

> thought they did, but didn't, I also know positively that some

women will try to get by for less by dishonest means.  So I require

proof, but I let the government agencies determine who needs

financial help.

>     Dee Kassing

>