Does insurance cover a doula?

How to request insurance reimbursement for doula services.

January 22, 2016

Bethanie Verduzco,

While doulas are known mostly for the emotional, physical and educational support we provide during labor, we also happen to be a pretty significant cost-saving tool for insurers, as well! This post is all about why doula services should be covered and how to go about attempting reimbursement.

For years, doulas have been working to get their services covered by insurance. And we’re getting there. Really, we are. One large study found that having a doula at your birth can lower the risk of costly interventions like c-sections and epidural anesthesia, lower the rate of NICU admittance, as well as increase the likelihood of spontaneous vaginal birth. The same study found that moms who have doulas at their birth have shorter labors and their babies are less likely to have low APGAR scores. Doulas can apply for their own National Provider Identifier (NPI) number, and there is now a CPT code covering birth doula (99499) and postpartum doula services (99501 and/or 99502), which makes getting reimbursed by insurance that much more possible. (CPT stands for Current Procedural Terminology, and is a copyright of the American Medical Association.)

I’ll be honest, though, the process is pretty hit or miss. So far as I know, anyways–I’ve never had a client attempt it, let alone have success. But from what I’ve heard from other doulas, it’s possible some parents may be partially reimbursed, fully reimbursed or not at all. But with more parents who attempt reimbursement, continued research and media coverage, we’re hopeful this process will start to change for the better.

On that note, a new study published in the journal Birth: Issues in Perinatal Care last week found that a certified doula’s services could save Medicaid and private insurers close to $1,000 per birth! This is huge, folks. The study compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care with similar women regionally, and concluded that coverage reimbursement for doula services would likely be cost saving or cost-effective for state Medicaid programs.

In an NPR piece published last week about the study, entitled Doula Support For Pregnant Women Could Improve Care, Reduce Costs, author Tara Haelle writes:

This is the first study to show a reduction in preterm births and a net savings for public insurance. Cesarean births — about a third of all U.S. births — cost about twice as much as vaginal births, and the 1 in 10 U.S. infants born preterm (before 37 weeks) incur medical costs 10 times greater than those of full-term infants.

“What is coming together now is a research consensus and a professional consensus of the benefits of doula care,” said lead author Katy Kozhimannil, an associate professor in the University of Minnesota School of Public Health. “The barriers to access are financial, cultural and geographic. The financial barrier ought to be the first to fall.”

So if there’s ever been a time to put yourself on the potentially frustrating but possibly rewarding path of third party reimbursement, it’s now! I’m happy to provide you with the documentation necessary to get you moving. Just let me know you’re going to give it a shot!

HERE’S WHERE TO START:

The following is a partial list of insurance companies who have reimbursed in whole or in part for doula services. (If your insurance company isn’t listed, it’s still worth attempting reimbursement. This list was first published in 1998, so policies may have changed.)

   •   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
•   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.

HOW TO REQUEST INSURANCE REIMBURSEMENT FOR DOULA SERVICES

1. _____ Pay your doula in full.

2. _____ Get an invoice from her which includes the following information:
a. The doula’s name and address
b. Her social security number, taxpayer ID or NPI number
c. The date and location services were provided
d. The CPT code for the services provided (99499 for Labor Support and/or 99502 for Postpartum Care)
e. A diagnosis code
f. The doula’s signature

3. _____ Submit the invoice with a claim form to your insurance company.

4. _____ Within 4 weeks, you may receive a letter telling you that either:
a. they need more information before they can process your claim.
b. this is not a covered expense.

5. _____ Ask your doula to send you the following:
a. a copy of her certification document
b. other credentials or relevant training
c. a letter detailing her training and experience and what she did for you

6. _____ If possible, ask your obstetrician or midwife for a letter explaining why a doula helped you, was necessary, or saved the insurance company money (i.e. Did you have a high-risk pregnancy? Did the doula’s suggestions appear to prevent complications or help your labor to progress more quickly? Did the doula’s presence decrease your need for expensive pain medications?).

7. _____ Write a letter explaining why you felt the need for a doula and how you believe the doula was beneficial to your health.

8. _____ Submit to your insurance company:
a. the doula’s letter and credentials
b. the letter from the doctor
c. your cover letter
d. abstract of 2012 update to the Cochrane Review study, Continuous support for women during childbirth.
e. abstract of 2016 Birth study, Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery.

9. _____ If they refuse it, write a letter to Health Services requesting that they review the claim, as you feel it was a cost-cutting measure and they should cover the cost. Include the abstract of both the 2012 update to the Cochrane Review study, Continuous support for women during childbirth and the 2016 Birth study, Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery.

10. _____ Follow up by telephone if necessary.

11. _____ If they refuse, write a letter to the CEO explaining why you feel that doula care should be a covered expense. Again, include the abstract of both the 2012 update to the Cochrane Review study, Continuous support for women during childbirth and the 2016 Birth study, Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery. They may not pay your claim, but they will consider it for the future.

(c) Kelli Way, ICCE, CD(DONA) 1998, Reprinted with permission.