Does Health Insurance Cover Doulas?

Currently, most health insurance companies do not openly cover doulas. This is slowly changing and there are steps you can take to see if your insurance company might offer at least partial coverage if not full reimbursement.

How Much Does It Cost To Hire A Doula?

The cost of hiring a doula depends on:

• Their experience;
• Where you live;
• The extent of services you need.

Hiring a doula usually starts at around $200. At the highest end, a doula could cost $3,500. As you can expect, the price will be higher in expensive cities such as New York and Los Angeles. But that does not mean that you can’t find affordable options even in those cities. Because the cost of a doula can vary so widely, it is always a good idea to find out ahead of time if your insurance provider will cover or reimburse the cost of doula services.

What Does The Doula Cost Cover?

Doula services itself vary. Do you want several prenatal visits and extensive postpartum assistance? Or do you just want a straight-up labor and birth doula services? Help during pregnancy can help you ease your anxiety from tips for relaxation during birth, or understanding how your body and hormones work during pregnancy, for example. Or even to understand common infections or complications during pregnancy. This support can make a difference in how you experience your pregnancy and labor. Most doulas are flexible and can customize their assistance according to what your needs are. Doula services such as childbirth consultations, birth planning, childbirth, and parenting classes are key to maximize your birth experience. As so, your expenses are going to depend on which of these services you are looking for.

Does My Insurance Cover a Doula?

We get the question “does my health insurance cover a doula” quite frequently, and rightfully so. The support a doula provide can decrease the cost of health care along the way and is definitely not a luxury to hire one. While health coverage for doula services is not yet common practice among insurance companies, it is coming to light more, and there are steps you can take even if your insurance provider doesn’t specifically cover doula service. There are more insurance providers offering coverage so the first step you need to take is to contact your provider and find out if they do.

There are two ways a claim can be filed for doula services and you would have to discuss which way with your doula. They probably have dealt with some insurance companies and can be a great resource for you if they don’t file the claim directly. Most don’t file directly but will assist you with what you need to be reimbursed for some or all of the fees you incurred.

Is hiring a Doula Worth it?

Did you know hiring a doula could save you money?

Having a Doula Can Save You Money

Yes, hiring a doula can actually save you money! The current statistics is that one in three births are surgical. Studies in Oregon, Minnesota and Wisconsin have shown that having a doula can actually save you money.  The average C-section costs 50% more than a vaginal birth, and studies show that having a doula can reduce the risk of a surgical birth by up to 50%. If you follow my math this is a win for both the client and insurance companies. That is why some insurances are starting to cover doulas! Medicaid has started covering doula services in the above-mentioned states. Progress is slow. In general, it takes 20 years to see a change implemented in the hospital setting. However, that is in part due to the rate of reimbursement being significantly lower than actual doula services cost.

How To File An Insurance Claim For Doula Coverage

When filing a claim for a doula coverage, you first need to speak with your insurance provider and be sure you collect the necessary information from your doula. You will most likely need to pay your doula in full to begin with and wait for your insurance to reimburse you.

My Baby Lady Can Help You With Insurance Claims

My Baby Lady, Inc., will work with you to file the claim and if acceptable to your insurance company, we will always file the claim; collecting only your co-pay which can be paid in a lump sum or over time.
We have helped clients with insurance reimbursement for Doula services and have put together a quick summary of what is necessary:

• A receipt from your doula that includes her full name, address, SSN, taxpayer ID AND NPI Number.
• Your doula MUST HAVE an NPI Number that is used in conjunction with the taxonomy code “374J00000X”. This taxonomy code refers to birth and postpartum doula service.
  • Be sure the receipt has the dates of services provided from beginning date to end date as well as the location the services were provided at (your home address for visits, your birthplace, if other than home for birth services.)
• The total charges for her service, payment method
  • Your name
  • Your doula’s signature

You also want to be sure she includes a diagnosis code, and the two used by your doula would be:

• V22.2 “Pregnant State, Incidental
  and for postpartum support
• V24.2 “Routine Postpartum Follow Up.”

My Baby Lady has experience dealing with insurance claims and reimbursents for Doula services

You will want to be sure you are using the correct form, so remember to contact your insurance provider for that information.

Within 30 days you should either be awarded your reimbursement, receive a request for additional information, or receive a denial letter.  If you receive a denial letter, do not despair.

My Insurance Denied Reimbursement For My Doula. What Do I do?

If the reimbursement for your doula was denied, don’t let this stop you from continuing to fight for coverage.  Prepare a new claim and copy everything to the insurance company’s CEO which you can find on the corporate website.  First, include everything you included with the original claim. Second, add a letter explaining why you think your claim is valid, why you need a doula, and how they were beneficial to your health and your overall wellbeing during childbirth labor and postpartum.  Ask your doula for a copy of her credentials and a detailed letter from her describing her training and experience along with what services she provided for you specifically.

There is a phrase my mom used all the time when I was growing up “the squeaky wheel gets the grease.”  Sometimes we need perseverance.

If your claim is denied a second time demand a reason. If they refer to your policy, request that they point out the precise clause and the wording that excludes doulas.

Does Medicaid Cover A Doula?

Florida and New York have been talking about adding doula services for their Medicaid recipients.  This is great news.  The amount of reimbursement right now is only $411.00 for 6 weeks of service. However, this is a giant leap in laying the groundwork for more insurance companies seeing the benefits for not only for their clients but for them, the insurer, as well.

At My Baby Lady, we will work with your insurance company to get the maximum coverage they will provide.  We will work directly with your insurance carrier if they do cover our services.  Furthermore, we will also work with you to provide all necessary documentation to receive reimbursement. That is if they do not explicitly say they cover doula services but at the same time don’t specifically exclude them. We hope that all health insurance does cover doulas in the near future as it is proven to health decrease birth costs and improve birth experience significantly.

The information contained on this site should not be construed as medical advice nor should it replace the advice and individual care of your health care provider.