Many who seek a doula in their birth journey don’t realize there is a possibility these invaluable services could be covered by their health insurance! While paying for services upfront is still necessary, your health insurance could reimburse you on the back end. Let’s be honest, who wouldn’t love a check in the mail several weeks after the baby’s arrival? You can never have too many funds on hand for diapers!
Getting Started
But before we get ahead of ourselves, the first step is to pay upfront for the services that are best for you and your journey. Once you have paid and the service has been rendered, request an invoice from your doula. This should include the following:
- your doula’s name and address,
- tax ID, or national provider ID (NPI)
- the date and location the services were provided,
- a CPT (procedure code) for the service,
- the diagnosis codes (ICD-10 codes) associated with your services, and last but not least,
- your doula’s signature.
Submit all this to your insurance company at the claims address on your insurance card. We’ve created a handy checklist and letter template for you to download.
Within four weeks, you should hear if this will be covered or if they are trying to deny coverage.
If Denied
If your insurance company tries to deny your claim, fear not, you can keep trying! Contact your doula about obtaining the following:
- A copy of their certification, if they are certified,
- Information on their training and other relevant skills they brought to assist you in your delivery, and
- A letter explaining your doula’s training and what they did for you during labor and delivery.
In addition, consider contacting your OB or midwife to write a letter on your behalf. They can explain why the doula’s services were necessary for your labor and delivery. A doula’s presence can help prevent complications. This saves on added expenses during labor, including pain medications saving your insurance money on reimbursement.
Also, write a letter of your own about why your doula’s presence was necessary for your birth. Feel free to include your thoughts on reducing complications, the need for pain medication, and the overall best health outcome for you and your baby. This is your opportunity to tell your story and advocate for yourself and your needs, as well as be an advocate for others trying to get these services covered.
Please note that all insurance companies and policies within each company are different. So, while you and someone you know may both have Insurance Company A, more than likely, you are both covered under different policies, so their plan’s coverage of doulas may look different than yours.
Calling Your Insurance
It’s always a good idea to call your insurance company to discuss doula services and whether their coverage is part of your policy. If you make this phone call, document who you spoke with, the date, and a reference number. This information could be a valuable asset if you have to appeal your claim, but hopefully, it won’t have to go that far.
Even if, on the phone call, you are told doula services are not covered, you can still follow the process to try for reimbursement. The worst they can say is no, but at the same time, you are showing the industry there is a need for these invaluable services and creating a squeaky wheel, if you will, for consideration in the future to get these services properly covered. You never know. You might get your doula services covered by insurance!
Hopefully, there will be standardized coverage for doula services one day, but until that day comes, we must show why these services are needed, and it takes everybody.
Information for this blog was obtained from SBD (Kelli Way, ICCE, CD(DONA) 1998.
