Tranquil Moments Doula, LLC

Did You Know? Doula Services are Covered By Insurance

 

 

Would you love to hire a Doula but you honestly can't afford one? Fear not! Your Health Insurance may cover it!


Many Health Savings Accounts and Flex Spending Accounts will reimburse for doula services.

 

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 your insurance company might reimburse at least some portion of the fee for your services might make you pretty excited. If you are interested in giving it a shot then please follow the steps listed below.

 

The following is a partial list of insurance companies 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 & 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

Qualchoice

Summit Management Services, Inc

Travelers

United HealthCare of Georgia (San Antonio, TX)

United Health POS

Wausau Benefits, Inc

 

How to Request Insurance Reimbursement for Doula Services

 

___     Pay your doula in full.

___     Get an invoice from her which includes the following information:

a. The doula's name and address

b. Her social security number/taxpayer ID number or NPI number

c. The date and location services were provided

d. The CPT code for the services provided

e. A diagnosis code

f. 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

a. They need more information before they can process your claim.

b. This is not a covered expense.

___     Ask your Doula to send you the following:

a. A copy of her certification (if she is certified)

b. Other credentials or relevant training

c. 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. Reprinted with permission.)