Insurance Coverage & Financial Planning for Doula Services

A doula for every person who wants one!

We believe that doula support should be a standard service in our maternal health care system. The benefits of doula support are well documented and growing. One of the leading barriers to doula support is cost. Through increased insurance coverage, reimbursement through FSAs and HSAs, and other financing tips, we hope to expand doula services to more families. (The following information is adapted, with permission, and expanded, from an article published on Quote Wizard.)

Will My Health Insurance Cover Doula Services?

Coverage for doula care is not yet routine among insurance companies. It's fortunately becoming more common. A growing number of insurers now cover doula services. You'll want to call your insurance company to see if they’re one of them.

After that, be sure to speak to your doula team to discuss the procedure for filing an insurance claim.

Doulas and Medicaid

Medicaid has started to show how covering doula services can benefit to both mothers and insurers. As of right now, Oregon and Minnesota are two states that permit Medicaid coverage for doula services. Currently, progress is slow, in part due to reimbursement rates being quite below the cost of most doula’s services.

However, studies in Oregon, Minnesota, and Wisconsin have shown that using a doula can save money. Currently in the US, one in three births is a C-section. They cost about 50 percent more than conventional births. Since using a doula reduces the chances of the need for a C-section by 25 percent, the overall savings are obvious.

Filing the Claim

Again, speak with your insurer and your doula before filing the claim to make sure you have the required info. After that, the process will probably look like this:

  1. Pay your doula in full.
  2. Get an invoice from your doula that includes the following:
    • Your doula’s name and address
    • Your doula’s taxpayer ID number (or EIN) or National Provider Identification Number.
    • The date(s) and location of their provided services
    • Diagnosis codes: V22.2 “Pregnant State Incidental,” V24.2 “Routine Postpartum Follow Up.”
    • Your name
    • Total charges for services
    • Payment method
    • Your doula’s signature
  3. Submit your claim to your insurer. Chances are you’ll use the standard HCFA-1500 form. However, check with your insurance company first in case they use another form.

What You Can Do If Your Claim is Denied

Within 30 days after you submit your claim, you may receive a letter from your insurer stating one of two things:

  1. Request for more information before the claim can process.
  2. This is not a covered expense.

Don’t give up if this happens. It’s common enough that there are steps you can take to get your claim reviewed:

  1. Prepare a new claim form for your insurer to review again. Copy everything in the form to the insurer’s CEO (This info should be available through the company’s website.) Also include the following:
    • Another copy of the receipt
    • A prescription for doula services from your provider (if possible)
    • A letter to the CEO that explains why you think your claim is valid. Also explain why you needed the doula and how they benefited your health
  2. Ask your doula to send you the following to include with the packet:
    • A copy of a doula certification
    • Any credentials and relevant training
    • A detailed letter that describes training, experience, and the services provided

Persistence is key here. Make phone calls and escalate them as you feel needed. If your claim is denied again, call and ask for a specific reason. If they refer to your policy, request that they point out the precise clause and the wording that excludes doulas.

How Can I Get Reimbursed Through My HSA or FSA?

First, check to see if doula services are covered as a reimbursable service by your HSA or FSA program. After the birth of your baby or babies, submit an invoice to your HSA or FSA that includes the following:

  • The date of birth and doula services
  • A description of services provided
  • The dates and form of payments made to your doula

Other tips for coverage:

If you don't have access to insurance coverage or reimbursement, prepare for the cost of doula services by requesting contributions towards your doula services for your baby shower or if possible, monthly savings. One thing you can count on with pregnancy is time. You have 7-9 months to save. Where possible, plan ahead and set aside $100-$200 a month. You can also talk to your doula team about setting up a payment plan to spread out the payments into smaller chunks over time.

 

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