Doulas and Health Insurance
Doulas are becoming a more common part of American childbirth. The book Brought to Bed: Childbearing in America, 1750 to 1950, features first-hand accounts behind the grim reality of giving birth in the old days. One woman wrote that, months after giving birth in a hospital, she would “wake up remembering that lonely labor room and just feeling no one cared what happened to me, no one kind reassuring word was spoken by nurse or doctor. I was treated as if I was an inanimate object.” That’s where doulas come in. They've become a source of support during birth at home and hospital. This results in a more positive birthing experience as well as healthier mothers and babies. As more Americans learn about doulas, demand for their services grows. Especially in the black community. While enlisting a doula to help through the birthing process sounds like a great idea, it brings up an important question.
Does health insurance cover doulas?
Unfortunately, most insurance companies currently do not explicitly cover doulas. There are, however, steps you can take to convince your insurance company to offer at least partial coverage. As hiring doulas for childbirth becomes more common, so too will insurance coverage.
Will My Health Insurance Cover My Doula?
Coverage for doula care is not yet routine among insurance companies. It's fortunately becoming more common. Many 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 to discuss the procedure for filing an insurance claim. Chances are they've been through the process before and are a great resource for completing the claims process.
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. Progress is slow at the time, 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:
Pay your doula in full.
Get an invoice from your doula that includes the following:
Your doula’s name and address
Your doula’s SSN, taxpayer ID number or National Provider Identification Number. It's important that the doula has an NPI number. It's used with the taxonomy code below in order for you to get reimbursed. The date(s) and location of their provided services
Taxonomy code: 374J00000X. It's for doulas and appears under the heading “Nursing Service Related Providers Type.” Your doula is not required to be an RN or LPN to have an NPI number. The taxonomy code refers to services of doulas, including postpartum and antepartum doulas.
Diagnosis code. The common code used for prenatal and labor support is V22.2 “Pregnant State Incidental.” The code used for postpartum support is V24.2 “Routine Postpartum Follow Up.”
Total charges for services
Your doula’s signature
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:
Request for more information before the claim can process.
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:
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 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
Ask your doula to send you the following to include with the packet:
A copy of her certification
Her credentials and relevant training
A detailed letter showing her training, experience, and what services she provided for you
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.