Would you love to hire a Doula but you honestly can’t afford one? Fear not! Your Health Insurance may cover it!
There is a great post on BirthSource.com about Third Party Reimbursement for Doulas aka Insurance pays the Doula’s Fees.
Over twenty insurance companies have begun paying for doula services and, now that there is a CPT code covering doula services, this is more of a possibility than ever before. (CPT stands for Current Procedural Terminology, and is a copyright of the American Medical Association.) The CPT code commonly used to claim doula services is 99499 for Evaluation and Management Services/Labor Support.
The fact that their insurance company might reimburse at least some portion of the fee for your services might make you attractive to a group of potential clients who might not have been interested before. Getting reimbursement for doula services requires patience and persistence, but it can be done. If you are going to offer this as a possibility for your clients, you will also need to be willing to offer some guidance and, most likely, a fair amount of support, as they attempt to get reimbursed.
The following is a partial list of insurance companies have reimbursed in whole or in part for doula services:
Baylor Health Care System/WEB TPA
Blue Cross/Blue Shield
Blue Cross/ Blue Shield PPO
Degussa, a German Chemical Company
Elmcare, LLC, C/O North American Medical Management
Foundation for Medical Care
Glencare Managed Health Inc.
Great-West Life & Annuity Ins. Co.
HNTB (Peoria, IL)
Houston New England Financial, Employee Benefits (Fort Scott, KS)
Humana Employers Health
Lutheran General Physician’s Organization
Oschner HMO, Louisiana
Professional Benefits Administrators
Summit Management Services, Inc
United HealthCare of Georgia (San Antonio, TX)
United Health POS
Wausau Benefits, Inc
Thanks so much for April Kline for putting the list together.
How to Request Insurance Reimbursement for Doula Services
___ Pay your doula in full.
___ Get an invoice from her which includes the following information:
- The doula’s name and address
- Her social security number/taxpayer ID number or NPI number
- The date and location services were provided
- The CPT code for the services provided
- A diagnosis code
- The doula’s signature
___ Submit the invoice with a claim form to your insurance company.
___ Within four weeks, expect a letter telling you either that
- They need more information before they can process your claim.
- This is not a covered expense.
___ Ask your Doula to send you the following:
- A copy of her certification (if she is certified)
- Other credentials or relevant training
- A letter detailing her training and experience and what she did for you
___ If possible, ask your obstetrician or midwife for a letter explaining why a doula helped you, was necessary, or saved the insurance company money. (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?)
___ Write a letter explaining why you felt the need for a doula and how you believe the doula was beneficial to your health.
___ Submit to your insurance company: the doula’s letter and credentials the letter from the doctor your cover letter
___ 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.
___ Follow up by telephone if necessary.
___ If they refuse, write a letter to the CEO explaining why you feel that doula care should be a covered expense. They may not pay your claim, but they will consider it for the future. (Kelli Way, ICCE, CD(DONA) 1998.
If you are a doula, I suggest you click over and read the guide to getting a National Provider Number and helping your clients get reimbursed.
Also, here is a pdf from DONA with several FAQ’s on insurance reimbursement.
Doulas – Do you have a Provider Number? Have you had your services covered by insurance? Please share your experience!
SUCH A BIG THANKS FOR AnthroDoula for sharing this with us!