How to file for Insurance Reimbursement for doula services

 

 

                                                                How do I get my insurance to reimburse for doula services ? 

You may be wondering will my insurance reimburse for doula. There are currently many Insurance companies reimbursing for a Certified Birth Doula as well as Certified Postpartum doulas. I encourage my clients to call their insurance provider and inquire. Medicaid is currently in 3 states paying for a doula. It is not the full fee but it is a great start.

I will detail below how to do this. Do not let it deter you as it may seem like a lot but if you begin your work while pregnant and immediately after the birth send it in it is well worth it. Further more having me as your doula I will help you navigate thru this. Providing pre written forms and documents that will be pertinent to your own birth. Since I utilize the Mobile Doula App you will have all of the documents , billing codes and forms at your finger tips.

If any doula tells you that they can personally file your insurance claim please know that this is not possible.

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
  • Florida Blue
  • 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.

How to Request Insurance Reimbursement for Doula Services

First Pay your doula in full. Get an invoice from her . I utilize the Mobile Doula App for my clients and include all the needed forms to submit to your insurance that include My NPI number (only a certified doula can obtain a National Provider Number) My DONA Certification number and pertinent CPT codes and billing personal for you. I will also help you with wording your letters to submit.

Here are just some of the required information to submit:

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 (which I have available to my clients via the Mobile Doula APP)

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 (a certified doula is a requirement and currently three certifying companies are accepted; DONA , CAPPA and ICEA .

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 (I Highly  encourage this ), 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.

 

 

 

 

 

 

 

 

Written by Lisa Olschewske, CD DONA with permission from DONA