While doula care is non-medical in nature, it has both medical and cost benefits that have been proven in numerous randomized controlled trials. Doula services are not typically covered by insurance plans, but in recent years more and more people have had success in applying for reimbursement for the cost of doula fees from their insurance providers.
Payment is due in full to your doula at the time of service, but for those who would like to seek insurance reimbursement, I will do everything I can to assist you in navigating this process.
The information on this page is meant to serve as an educational resource and guide for seeking third party reimbursement for labor doula services.
Where to Begin
There are several types of third party payers who have reimbursed for doula services on an occasional basis. At this point, there seem to be insurance companies with better or worse records – most have a history of both denying and approving reimbursement claims on a random basis. The traditional indemnity plan (in which the consumer chooses any practitioner and is reimbursed for a percentage of covered expenses) seems more likely to cover independent doula services than health maintenance organizations or preferred provider organizations under managed care.
To date, Medicaid does not directly reimburse for doula services, although Medicaid funds are allocated for doula services by some county agencies. Many consumers have flexible spending accounts, in which a percentage of their wages are placed in a pretax account and can be used for non-covered medical expenses. Doula care may be considered an appropriate expense for reimbursement from a pretax account.
When a claim is submitted to an insurance company, the CPT code is entered into a database. The initial determination as to whether that code is a covered expense under that client’s health care plan is a computerized response. When the CPT code for doula services (a general, non-specific code) is entered, it rarely is automatically reimbursed, and the claim is usually rejected. After the initial rejection, the client may request a medical review at which time the claim will be reevaluated by an employee of the insurance company to determine whether it was medically necessary and is therefore reimbursable.
Supportive documents, such as a letter from your care practitioner “prescribing” doula services as a part of your care, and an explanation of the benefits of doula services (and how they save the insurance company money), can make the difference in an acceptance or denial of a claim.
How to Request Third Party Reimbursement of Doula Services From Your Insurance Company
- Pay your doula in full.
- Get an invoice from your doula which includes the following information:
a) the doula’s name and address
b) the doula’s NPI number (National Provider Identification)
c) the doula’s social security number or taxpayer ID number
d) the date and location services were provided
e) the CPT (Current Procedural Terminology) code for the services provided
f) a diagnosis code (which may need to be supplied by your doctor or midwife)
g) the doula’s signature
- Submit the invoice with a claim form (provided by your insurance company, or the 1500 universal claim form if required) to your insurance company.
- Within four (4) weeks, expect to receive a letter telling you either that:
a) they have accepted the claim
b) they need more information before they can process your claim
c) this is not a covered expense
- If the insurance company needs more information or denies your claim, ask your doula to send you the following:
a) a copy of her certification (if she is certified)
b) other credentials or relevant training
c) a letter detailing her training and experience and how she served you
- If possible, ask your doctor or midwife for a letter explaining how a doula helped you, was necessary or saved the insurance company money. (Did you have a high-risk pregnancy or postpartum? Did the birth doula’s presence and/or suggestions appear to prevent complications, help your labor to progress more quickly or decrease your need for expensive pain medications? Did the postpartum doula’s presence and/or suggestions help you or your baby in the postpartum period, increase breastfeeding success or appear to prevent postpartum complications?)
• Download an example letter as a PDF or Word Document.
- Write a letter explaining why you felt the need for a doula and how you believe the doula was beneficial to your and your baby’s health.
- Submit to your insurance company:
a) the doula’s letter and credentials
b) the letter from your doctor or midwife
c) your cover letter
- If they refuse your claim, write a letter to your insurance company to the attention of Health Services requesting that they review the claim, as you feel it was a cost-cutting measure and they should cover the expense.
- Follow up by telephone if necessary.
- If the insurance company continues to deny your claim, write a letter to the company CEO explaining why you feel that doula care should be a covered expense. They may not pay your claim, but they may consider doing so for future claims.
Information on this page is attributed to DONA International