How To Get Medical Insurance to Pay For Doula Services

Updated: Feb 11, 2021


FOR THE MOMMAS – WHAT YOU NEED TO KNOW UP-FRONT


You know you want to hire a doula, no – you know you NEED to hire a doula birth coach for educational, emotional and physical support for you and your husband as you welcome your little baby boy or girl into the world. You know all the benefits of hiring a doula, but you may be wondering how to pay for your doula. and more importantly, how to get your medical insurance company to pay for it. Understandable, as doula services can range from $800 to $3,500 depending on where you live in the United States. On average, the cost of hiring a doula for birth services, which typically covers unlimited phone, text, and email support, 2 prenatal visits, continuous labor & delivery support, and 2 postpartum visits, is around $1,300. Of course, that price is more if you need additional services, such as childbirth education or additional postpartum services, which could include breastfeeding counseling and/or specialized newborn/infant care education/support, or maternal wellbeing coaching.


You should expect to pay out-of-pocket for the full price doula services up-front when hiring your doula, then you will submit the receipt of your paid invoice and insurance claim form for reimbursement from your insurance company. Some insurance companies will cover all doula costs, while others will cover some of the associated costs.


Health Reimbursement Accounts (HRAs), Health Savings Accounts (HSAs), and Flex Spending Accounts (FSAs) can be used for eligible health care, dental, and dependent care expenses. Changes to your HRA, HSA, and FSA eligible reimbursements were updated with the passing of the CARES Act, and things like menstrual care and feminine hygiene products are now reimbursable, and over-the-counter drugs no longer require a prescription to be reimbursed. With all the added benefits, it’s worth trying to have your doula services covered.


Expenses paid for a doula, whose primary purpose is for labor & delivery support are considered reimbursable, whereas postpartum doula charges where the primary purpose is childcare are not covered. EDC doulas’ primary purpose of postpartum doula care is never childcare, as a matter of fact we do not provide childcare at all, and we are not high-priced nannies or maids. We provide newborn/infant care education, breastfeeding support, maternal wellbeing support, etc. An explanation of the primary purpose of doula care should accompany the claim as explained below. Parents are responsible for calling their own insurance company’s benefits department to have a clear understanding, preferably in writing, of what and how much your insurance company will cover and reimburse for doula services.


When interviewing your doula before hiring her, ask if she has an NPI (National Provider Identification) number. She must have one in order for you to submit an invoice/claim for reimbursement from your medical insurance company. If she does not have one yet, no worries, we cover how she can apply for one later in this article. Remember, you will want to hire your doula sooner rather than later to reserve your spot, as doulas only book a limited number of clients each month to ensure she is available for your due date. Adding doula services to your online baby registry is a great way to earn those up-front, out-of-pocket costs associated with having a doula. If your online baby registry does not have a section specific for doula services, you can choose “other” and specifically label it as your Doula Fund. But don’t forget to use your HSA, HRA, or FSA card to cover those out-of-pocket expenses if you can.


HOW TO IN 8 EASY STEPS


1. Call your insurance company to verify benefits and get it in writing what they will pay for doula services.


2. Pay your doula in full.


3. Get a receipt of your paid invoice from your doula. Make sure it has the following information on it before submitting to your insurance company: (Most insurance companies will not reimburse for doula expenses until after all services are rendered –after baby is born – so check on this with your insurance company)

a. The doula’s name, agency name, and address.

b. The doula’s NPI number.

c. The doulas taxonomy number.

d. The date and location where birth services were provided (exact name and address of the

hospital or birth center).

e. The doula’s monetary rates for services – flat rate or hourly rate, amount and date paid in

full.

f. The CPT code – the service code – is the 5-digit numerical code used to identify a medical

service or procedure.

g. The diagnosis code – called ICD-10 and it looks like CM Z33.1 or CM Z39.2

h. The doula’s signature.


4. Ask you doula for:

a. A copy of your doula’s certification document to submit with your insurance claim.

b. A letter from your doula detailing what she did for you and her qualifications/experience.


5. Ask your OB or midwife for a letter of necessity explaining why a doula was beneficial, necessary, and how having a doula saved the insurance company money (decreased need for pain medication, reduced risk for cesarean section, prevented complications, helped labor progress, and the like). Your insurance may have a specific form for this, so make sure to ask when calling to verify benefits.


6. Write your own letter explaining why you feel you needed a doula and how you believe she was beneficial to you and your baby’s health and wellbeing.


7. Print Evidence on Doulas and Cochrane Review, Continuous Support for Women During Childbirth and Birth Study, Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery


8. Submit your standard Health Insurance Claim Form (found here) with ALL of the following to your insurance company after baby is born:

  • Your letter to the insurance company.

  • The letter from your OB or midwife.

  • The invoice/claim.

  • A copy of written correspondence with insurance provider regarding covered doula expenses.

  • The copy of your doula’s certification.

  • The letter from your doula.

  • The 3 evidence-based articles.

By attaching and submitting all the above with your claim form, it can avoid unnecessary delays in reimbursement by your insurance carrier. Should they refuse your initial claim, follow up with a phone call, as well as a letter to the CEO if necessary, explaining why you feel doula care should be a covered expense.


 

FOR THE DOULAS


1. The first thing you need to do is be certified through a doula training agency. There are numerous agencies to certify with, so find one that aligns with your personal values (like being Christ-centered, conservative, pro-life, etc.), one that will give you the very best and most up-to-date, evidence-based education for your money, continuous support, and one that does not nickel and dime you to death with hidden fees or recertification fees – oh and one that does not charge you for each certification for birth doula, postpartum doula, childbirth education, fertility, newborn/infant care, breastfeeding, or pregnancy, infant and child loss bereavement, and one that does not dictate to you how to run your own business once you graduate. If that sounds like an answer to your prayers click here!


2. Next, you will apply for your NPI (National Provider Identification) number here and read through the Centers for Medicare & Medicaid Services website. Scroll down to Related Links to Apply Now – National Plan and Provider Enumeration System (NPPES Website). Create your new account. The process is not difficult. The NPI number is used in conjunction with the Doula Taxonomy Code 374J00000X, which falls under the Nursing Service-Related Providers, even though doulas are not nurses. There are other taxonomy codes for lactation counselors – but lactation counselors cannot bill for doula services if they are not a doula – but a doula that is also a breastfeeding counselor can bill for lactation counseling services. There are also taxonomy codes for level II providers, which would be for your IBCLC and other licenses. You can search the doulas on the NPI Registry and filter by state to see the provides who have their doula NPI numbers.



Photo Credit: Mobile Doula App


3. Now the next best thing you can do is get the Mobile Doula App for as low as $17/mo. and make your life so much easier. Mobile Doula App is a platform to manage your doula and lactation practice that offers electronic charting, you can easily upload new clients, chart/record prenatal visits, birth preferences, postpartum visits, etc., and with a few clicks, you are able to provide your clients with an invoice, complete with the most up-to-date CPT and ICD-10 codes for your doula services including childbirth education classes, lactation classes, parenting classes, infant safety classes, stress management classes, preventative counseling, newborn care, and so on. You can see a sample superbill (invoice) on their FAQ Billing page.


4. Or you can go old school and use the standard Health Insurance Claim Form (found above) and use the correct CPT and ICD-10 codes and provide that to your client for reimbursement.



FREQUENTLY USED CPT AND ICD-10 CODES


In order to be reimbursed by insurance you will need very specific diagnosis and procedure codes, as designated by the Healthcare Common Procedure Coding System. In addition, HD is the specific “modifier” for the Pregnant/Parenting Women’s Program.


ICD-10 Diagnosis Codes


Encounter for childbirth Instruction - diagnosis code Z32.2

Encounter for childcare instruction – diagnosis code Z32.3

In all cases where ICD-9 code V22.2 was previously used, Z33.1 is now the current ICD-10 billable diagnosis code for pregnancy.

Encounter for care and exam of mother immediately after delivery is Z39.0

Encounter for care and exam of lactating mother is Z39.1

Postpartum routine follow-up use diagnosis code Z39.2

*When billing for prenatal home visits you can use both Z32.2 and Z33.1 – and for postpartum home visits use Z39.1 and Z39.2


CPT Procedure Codes


There are different modifiers for clients who are 19 years or younger, and they are billed as Enhanced Doula Care, which allows for more prenatal visits. Clients over 19 at the time of initial services are considered Standard Doula Care.


Standard Care CPT Codes


Code/Modifier Description

99600 -HD -21 Initial Prenatal Visit / Home Visit Service

99600 -HD Standard Care Prenatal Visit / Home Visit Service

59409 -HD Labor Support / Vaginal Birth

59514 -HD Labor Support / Cesarean Birth

99199 -HD Unlisted Special Service / Standard Care Postpartum Visit


Enhanced Care CPT Codes


Code/Modifier Description

99600 -HD -21 Initial Prenatal Visit / Home Visit Service

99600 -HD - 22 Enhanced Care Prenatal Visit / Home Visit Service

59409 -HD Labor Support / Vaginal Birth

59514 -HD Labor Support / Cesarean Birth

99199 -HD -22 Unlisted Special Service / Enhanced Care Postpartum Visit


Childbirth Education


Code/Modifier Description

S9436-HD Services / Childbirth Education



HOW DO I COMPLETE SECTION 24 ON THE CMS-1500 CLAIM FORM?


The following is an example of how to complete the CMS-1500 Claim Form as it relates to childbirth education:


Field No. Name Entry

24B Place of Service Enter Place of Service. For example: code 99 (other); 11 (office)

24D Name of Service Enter HCPCS code S9436 with modifier HD (S9436-HD).

24E Diagnosis Code Enter diagnosis code Z32.2

24F $ Charges Enter your usual and customary charge.



SAMPLE DOULA LETTER TO THE INSURANCE COMPANY


You can find a sample doula letter to submit to the insurance company at Holistically Love.


XOXOXO


Vicki



#childbirth #gettingreadyforchildbirth #doula

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