Will My Insurance Company Cover Birth Doula Support?

Insurance reimbursement can be intimidating, but don’t worry. I can help you navigate what to do. Doulas are our own category—we don’t provide healthcare, but we operate through a lot of the same systems. There are TWO main ways to avoid paying out of pocket, or to get reimbursed: 1) Use your Health Savings Account (HSA) and/or Flexible Spending Account (FSA), and 2) File an insurance claim

1) Use your HSA and/or FSA

If you don’t have an HSA or FSA, skip down to #2.

This process can be pretty easy if you’re prepared ahead of time with the right documentation, because doula services count as qualified medical expenses. That means you can pay your entire doula fee using these accounts, or reimburse yourself if you pay out of pocket. There are three things you should obtain to make things go smoothly:

  1. Evidence of payment, either:
    • An itemized receipt from all services provided, if you paid out of pocket
    • An itemized invoice signed by your doula, if you can pay directly from your HSA/FSA account
  2. A letter from your doula explaining what services they provide, and how they help(ed) you.
  3. A letter from your obstetrician or midwife explaining how your doula helped you.

To help your doula and/or provider write these letters, think about these questions, and be sure to mention them when you ask for the letters:

  • Do you have mental health problems, or have you had them in the past?
  • Do you have any health concerns that are unrelated to your pregnancy, but still make things harder?
  • Do you have any pregnancy complications? Any concerns that there could be complications?
  • Was the baby optimally positioned, or were they facing forwards, so you experienced ‘back labor?’
  • Are there any interventions or medications that your provider did not have to use because you were coping so well with your doula?
2) File an Insurance Claim

The second method is by filing a claim for reimbursement with your insurance provider. Doulas cannot personally file your insurance claim. That means you will have to pay your doula in full, and then see if your insurance company will reimburse you. Unfortunately, Medicaid does not cover doula services in Michigan, but many private insurances may offer a reimbursement.

Here’a what you need to file an insurance claim: [1]

  1. Your doula’s name and address
  2. Your doula’s National Provider Identification (NPI) Number. They have to register, so ask them if they have an NPI.
    • This must be used with the doula taxonomy code—374J00000X for you to get reimbursed.
    • This falls under the heading “Nursing Service Related Providers Type.”
  3. The date(s) and location of their provided services
  4. Diagnosis or CPT code(s):
    • Prenatal and labor support is usually V22.2 “Pregnant State Incidental.”
    • Postpartum support is usually V24.2 “Routine Postpartum Follow Up.”
  5. An invoice from your doula, including:
    • Total charges for services, itemized
    • Payment method
    • Your doula’s signature

These documents may not be required, but they can help get you claim approved:

  1. A copy of your doula’s certification, if they are certified with DONA , CAPPA or ICEA, and any other credentials or relevant training
  2. A letter from your doula explaining what services they provided, how they helped you, and how they saved the insurance company money.
  3. A letter from your obstetrician or midwife explaining how your doula helped you, why they were necessary, and how they saved the insurance company money. See above for questions to get you thinking about what to include!
  4. A letter from yourself explaining why you needed a doula, how your doula benefited you, and how your doula saved the insurance company money.

Here’s a list of insurance companies that have reimbursed for doula support: [2]

  • Aetna Healthcare
  • AltPro
  • Baylor Health Care System/WEB TPA
  • Blue Cross/Blue Shield
  • Blue Cross/Blue Shield PPO
  • Cigna
  • Degussa, a German Chemical Company
  • Elmcare, LLC, C/O North American Medical Management
  • Florida Blue
  • Foundation for Medical Care
  • Fortis Insurance
  • Glencare Managed Health, Inc.
  • Great-West Life & Annunity Ins. Co.
  • HNTB (Peoria, IL)
  • Houston New England Financial, Employee Benefits (Fort Scott, KS)
  • Humana Employers Health
  • Lutheran General Physician’s Organization
  • Maritime Life
  • Medical Mutual
  • Oschner HMO, Louisiana
  • Professional Benefits Administrators
  • Prudential Healthcare
  • Qualchoice
  • Summit Management Services, Inc.
  • Travelers
  • United HealthCare of Georgia (San Antonio, TX)
  • United Health POS
  • Wausau Benefits, Inc.

If your insurance company is not on your list, you should still give it a try!

Sometimes insurance companies will not approve your claim. Just because these companies have reimbursed in the past, does not necessarily mean that they will do so on your first try. If your claim is refused, here are some steps you can take:

  1. Find out exactly why your claim was denied. What specific clauses say that doula services are not covered?
  2. Follow up by telephone, if necessary.
  3. Re-file the claim, and copy the CEO of the insurance company in your resubmission. This time, make sure you definitely include a letter from you, your doula, and your provider.

These things are complicated, right? Don’t worry. I can help you work through the nitty gritty!

References:

  1. QuoteWizard, by Lending Tree: Doulas and Health Insurance. Found at QuoteWizard.com
  2. Graceful Beginnings Doula Services: Using your FSA +HSA for Doula Services and how to obtain Reimbursement. Found at Graceful Beginnings Doula Services

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: