How Do I get My Insurance Company to Pay For Doula Services??

WARNING: This post is going to be very wordy with a lot of insurance speak, but we'll get through it...
**Also, this post is a compilation of a few websites to get you the most comprehensive information to get you started on your way to getting your services covered. I did not write down sites, but much credit is due.**

How to Obtain Reimbursement for Doula Services

Insurance coverage of Doula services is becoming a more common occurrence in the birthing world. Virtuously B’Earthed Doula Services encourages you to take the following steps to attempt reimbursement of your Doula services through our programs. We are happy to provide you with the necessary documentation to move forward with an insurance reimbursement.

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 used to claim birth Doula services is 99499 for Labor Support and to claim postpartum Doula services, it is 99501 and/or 99502 for Postpartum Care.

The following is a partial list of insurance companies who have reimbursed in whole or in part for Doula services:

• 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.

Insurance and Flexible Spending Account Coverage:
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Some insurance companies will pay for Doula services by reimbursing you. You may also submit to your medical flexible spending account (cafeteria plan) to help reduce your costs.
How to Request Insurance Reimbursement for Doula Services:

1. Pay your Doula in full.
2. Get a receipt from Virtuously B'Earthed Doula Services which includes the following information:
   • The Doula’s name & address
   • The Doula’s social security number/taxpayer ID number and/or NPI number
   • Diagnosis Code (V22.2, intrauterine pregnancy/ V24.2, routine postpartum follow up)
   • The CPT code for the services provided ( 99499, labor support/ 99501 and/or 99502, postpartum care)
   • Taxonomy Code (374J00000X)
   • The date and location services were provided
   • The Doula’s signature
   • The mother’s name
   • Total charge for services
   • Dates & amounts of payments
   • Payment method
3. Submit the invoice with a claim form to your insurance company or flexible spending account company’s claim department.
4. Within a month, you should receive a response telling you either that:
   • They have accepted your claim.
   • They need more information before they can process your claim.
   • This is not a covered expense.

If the insurance company needs more information or denies your claim:

1. Do not be discouraged. Prepare a new packet to resubmit to your insurance company for a secondary review, and copy everything in the packet to the insurance company’s CEO explaining why you feel services should be covered. In this re-submission packet, you should include the following:
   • Another copy of the receipt
   • A letter from you to the CEO explaining why you think you should be covered as well as why you felt the need for a Doula and how you believe the Doula was beneficial to your health
   • DONA’s position paper
   • Ask your Doula to send you the following and include in your packet:
     1. A copy of her certification (if she is certified)
     2. Other credentials or relevant training
     3. A letter detailing her training and experience and what she did for you
     4. If possible, ask your Doctor or Midwife for a letter explaining how a Doula helped you, was necessary, or saved the insurance company money. (Did you have a high-risk pregnancy or postpartum? Did the birth Doula’s presence and/or suggestions help you or your baby in the postpartum period, increase breastfeeding success or appear to prevent postpartum complications?)
2. 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 most.
3. Be persistent. Make phone calls if necessary. If your claim is ultimately denied, call and ask for a specific reason why. If they refer to your policy, ask them exactly what clause and what wording in your policy excludes Doula services. They may not pay your claim, but they will consider it for the future.

Whether you are reimbursed or not, please let Virtuously B’Earthed Doula Services know what kind of response you get from the insurance company. Each time someone requests reimbursement, it tells the insurance companies that this is an important service. They may consider it more carefully next time. If you are reimbursed, this is great news for doulas and we always want to know!