Insurance and Flexible Spending Account Coverage

Insurance companies are starting to recognize the excellent value in a doula! Some companies will pay for a doula as an out-of-network provider by reimbursing you after the birth. You may also request reimbursement from your medical flexible spending account (cafeteria plan).

How to get insurance reimbursement for doula services:

1. Pay for my services in full. If you plan to submit to your insurance for reimbursement, please tell me early in our relationship. I may need to provide you with some additional paperwork that requires documentation at many of our meetings.

2. Get a receipt from me after the birth. The receipt will include the following information:

• my identifying information
• the diagnosis and CPT code
• the date and location services were provided
• your name
• total charge for services
• dates and amounts of payments
• payment methods

3. Submit the receipt with a claim form to your insurance company's claims department.

4. Within a month, you should receive a response. If you receive a letter denying the claim, 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 (and be sure to point out how much the insurance company saved because of the services your doula provided). In the resubmittion packet, you should include the following:

• another copy of the receipt
• a letter from you to the CEO explaining why you think this should be covered
• a letter from me stating the benefits of doula care
• DONA's summary paper about the research on doula care
• DONA's Position Paper: The Doula's Contribution to Modern Maternity Care
• if your doctor or midwife is willing, include a letter from them stating why they feel the additional support of a doula was beneficial

5. Be persistent. Make phone calls if necessary. If your claim is ultimately denied, call and ask for a specific reason why it was denied. If they refer you to your policy, ask them exactly what clause and what wording in your policy excludes doula services.

6. Whether you are reimbursed or not, please tell me what kind of response you get from your insurance company. Each time someone requests reimbursement, it tells the insurance companies that this is an important service. They may consider it more carefully in the future. If you are reimbursed, this is very good news for doulas and I always want to know! I will want to know exactly what you had to go through to get reimbursed and what insurance company you have.

Good luck!