Getting Doula Services Covered

Doula Ambitions and Birthsource together have made wonderful posts on insurance reimbursement for doula services.

There is a great post on BirthSource.com about Third Party Reimbursement for Doulas aka Insurance pays the Doula's Fees.

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 their insurance company might reimburse at least some portion of the fee for your services might make you attractive to a group of potential clients who might not have been interested before. Getting reimbursement for doula services requires patience and persistence, but it can be done. If you are going to offer this as a possibility for your clients, you will also need to be willing to offer some guidance and, most likely, a fair amount of support, as they attempt to get reimbursed.

The following is a partial list of insurance companies have reimbursed in whole or in part for doula services:

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
Thanks so much for April Kline for putting the list together. 

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. 

1 comment:

Anonymous said...

Very energetic post, I liked that a lot. Will there be a part 2?
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