UPDATE: After connecting with a DONA trainer, we removed any reference to CPT codes. Though many doulas have used various CPT codes in the past and their clients successfully received reimbursement for both labor and postpartum doula services, as there is not a specific CPT code for doula services, DONA recommends not using a CPT code when filing for reimbursement. We hope that through continued advocacy, a specific CPT code for doulas will be created in the near future.
We firmly believe that professional doulas should make a living wage. I even wrote an article in March detailing Why Doulas are Expensive, and why that's a very good thing for everyone. In almost every other profession, passion and purpose are not reasons NOT to charge what you’re worth.
But, that’s not what we’re talking about here. We’re not talking about what a doula should charge. We're talking about the women who can't afford a doula (and yes, these women exist in every city, in every town).
Many women can afford to pay a doula out-of-pocket...but what about the women who can't?
If we believe doulas should make a living wage, how do we help keep the cost of birth down for those who want doulas and genuinely can't afford one?
Did you know that many insurance companies are beginning to provide partial (and sometimes full) reimbursement to customers for doula services?
Though each client is ultimately responsible for reimbursement, and we certainly can not guarantee any reimbursement, at Cord Doula Collective, we partner with each of our clients to ensure they have the best chance possible at receiving reimbursement for doula services.
Over twenty insurance companies have reimbursed clients in the past for labor doula services. Though seeing your insurance company on this list does not guarantee reimbursement, it certainly is a positive sign.
Insurance Companies with a History of Doula Support Reimbursement:
- Aetna Healthcare
- 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
- Fortis Insurance
- 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
- Maritime Life
- Medical Mutual
- Oschner HMO, Louisiana
- Professional Benefits Administrators
- Prudential Healthcare
- Summit Management Services, Inc
- United HealthCare of Georgia (San Antonio, TX)
- United Health POS
- Wausau Benefits, Inc.
Even if your insurance company is not on this list, take heart! With some recent adjustments in the insurance world regarding doula support, we have a better chance each year in normalizing reimbursement!
Before we cover the steps to seeking reimbursement, let’s cover a few of acronyms and terminology of the insurance world:
- NPI [National Provider Identifier] Code: Doulas can now register with the NPPES (National Plan and Provider Enumeration System) to be assigned an NPI number. Listing this number to prove that you doula is registered with the NPPES increases the likelihood of reimbursement.
- Taxonomy Code: Taxonomy Codes are unique, 10-digit administrative codes identifying the provider type and area of specialization on a claim level.
- Diagnosis Code: The Diagnosis Code is the translation of written description of the condition the providers were “treating” (in this case, intrauterine pregnancy).
Steps for Requesting Reimbursement for Doula Services
- Pay your doula in full.
- Request an invoice from your doula that includes the following information:
- Doula’s name and address.
- The date and address for the location services were provided.
- Taxonomy Code for doula services: 374J00000X
- NPI Number: [Cord Doula Collective’s NPI number: 1689044323]
- Tax ID or Social Security Number
- Diagnosis Code: Z33.1 Intrauterine Pregnancy
- The doula’s signature
- Prepare a cover letter than includes a description of a doula (this site has an efficient presentation of what a doula is and the benefits she provides), and the specific benefits she provided to you as a part of your birth team (be sure to list any medical interventions her support helped you avoid - this saves the insurance
- Submit this invoice along with a claim form to the insurance company.
- Within four weeks after submission, you should receive a letter stating that either:
- More information is required to process the claim, OR
- Doula services is not a covered expense.
- In preparation for round two of submitting for reimbursement, request your doula send you:
- A copy of your doula’s certification (if she is certified).
- Any other relegation credentials or training.
- A letter describing the services she provided you, the benefits to you (possibly even how her support reduced the need for medical intervention, thus saving the insurance company money), and the training she received that equipped her for this role.
- If possible and you have the relationship that affords this type of request, ask your midwife or doctor to provide a letter detailing how the doula helped you and provided for a healthier, safer delivery.
- Submit the above along with the letter from your provider to your insurance company.
- 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.
- 1-2 weeks after submission, make a telephone call to check on the claim.
- If they refuse, write a letter to the CEO explaining why you feel that doula care should be a covered expense.
Even if your insurance company does not reimburse you for this expense, each time one of our client’s submitted a claim for reimbursement, we are increasing the awareness around doula services.
And for the many women who don't have insurance, we still believe they should have access to doula support. There are many wonderful non-profits sprouting up around the country that are finding ways to pay their doulas a living wage AND give families access to labor support. We shouldn't be threatened by this. We should embrace and support it.