Healthy Living Made Easy

One of the big questions I get asked  is... if I hire a doula, will my insurance company cover her fees?  And if so, how do I go about it?  This is a very good question because as we all know, having a baby is not cheap. Here is some good news. 

Insurance companies are finally recognizing that doulas can actually help lower costs thanks to a number of studies.  There was a fairly large study involving 15,288 women that found having a doula present at a woman's birth can shorten her labor time as well as lower the risk of costly interventions such as cesarean sections, instrumental usage and epidural anesthesia. Women allocated to continuous support were more likely to have a spontaneous vaginal birth.  They also found it was good for baby too. The study found that the babies were less likely to have low APGAR scores and lower rates of NICU admittance. 

There are twenty+  insurance companies that have begun paying for doula services. You will have to call your insurance company to see if they participate. And if they do you will have to find out if they'll cover all the expense or just part of it. 

There is a special CPT code (CPT stands for Current Procedural Terminology, and is a copyright of the American Medical Association) covering doula services. Here is the special CPT code:

• Birth doula (99499) for Evaluation and Management Services/Labor Support.
• Postpartum doula services (99501 and/or 99502).
• Registered Nurse (99500)

The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign NPI numbers. 

“Doulas work in a variety of settings and have been trained to provide physical, emotional, and information support to a mother before, during, and just after birth and/or provide emotional and practical support to a mother during the postpartum period.”

How to Request Insurance Reimbursement for Doula Services

 1.) Pay your doula in full.

 2.) Get an invoice which includes the following information:

a. The doula's name and address.

b. Her NPI number.

c. The date and location services were provided.

d. The CPT code for the services provided.  Birth doula (99499), this is a nonspecific code described as “Evaluation and Management Services” and can be applied to the prenatal, birth and postpartum periods when coupled with the appropriate diagnosis codes. 

Postpartum doula services (99501 and/or 99502/and or 59430) The CPT code 59430 is also an unspecific code described as “General Postpartum Care” and can be applied to the postpartum period when coupled with the appropriate diagnosis code."

e. A diagnosis code. The diagnosis code typically used for prenatal and labor support is V22.2 “Pregnant State Incidental.” The diagnosis code typically used for postpartum is V24.2 “Routine Postpartum Follow Up.” 

f. The doula's signature.

3.)  Submit the invoice with a claim form to your insurance company.  The standard claim form that is usually used is (HCFA-1500).  However your provider may have a different form and they should be able to provide you with the necessary form.

4.)  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.

5.)  Ask your Doula to send you the following:

a. A copy of her certification if needed

b. Other credentials or relevant training if needed

c. A letter detailing her training and experience and what she did for you (Doula will provide)

6.)  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?)

7.)  Write a letter explaining why you felt the need for a doula and how you believe the doula was beneficial to your health.

8.)  Submit to your insurance company: the doula's letter and credentials, the letter from the doctor and your cover letter.

9.)  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.

10.)  Follow up by telephone if necessary.

11.)  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.