Insurance Reimbursement
Doula dollars for you?
New for 2010!
DONA‘s vision statement is “A doula for every woman who wants one” but the reality up until now is actually a doula for every woman who wants one and can afford one. With all the expenses new parents face, budgeting for doula services can be tough. I’m delighted to announce that there has been progress made recently on insurance reimbursement for doula services.
As a DONA certified doula with an active National Provider Identifier (NPI#), I may be able to help you with third party reimbursement from your health care insurance company.
Historically, doula work has not been covered by insurance. However, in 2009, a birth doula and registered nurse in South Carolina named Pat Burrell was successful in lobbying for the assignment of the code, which allows doulas to secure provider numbers to submit claims to both Medicaid and third-party payers for their services.
In 2009, a taxonomy code (374J00000X) was assigned to the role of a Doula and identified under the Nursing Service Related Providers Type. The following Doula Classification was added:
“Doulas work in a variety of settings and have been trained to provide physical, emotional, and informational support to a mother before, during, and just after birth and/or provide emotional and practical support to a mother during the postpartum period”
Reimbursement will be up to your insurance provider and is, of course, specific to your plan. It is brand new and the kinks are just starting to reveal themselves which will take time to work out. I am only stating that there is potential for reimbursement and inviting you to check with your provider to see what may be covered. I would never want to put a family in a bad financial position where they are expecting reimbursement for services they have paid for.
The taxonomy code and NPI number do not guarantee reimbursement, but they do remove the major obstacles to reimbursement that have existed up to this point.
If you are going to try to seek reimbursement, there is some basic information which you need to be aware of. This will be important when you are choosing your doula.
Here are the codes which may be helpful for the insurance companies. The codes are separate for birth and postpartum help.
For birth:
The best case I have heard of for birth support was 100% reimbursement of the doula’s fee for labor services.
For postpartum:
The best case I have heard of for postpartum support was 50 separate 4-hour visits (200 hours) reimbursed for postpartum services.
The doula must:
1) be certified and provide proof of certification from a recognized organization such as DONA
2) have a NPI number registered for doula work (taxonomy code: 374J00000X)
3) be willing to help you with writing letters to your insurance company if they deny the claim, which often happens the first time around
Please note, I do not have a lot of background with dealing with insurance companies. As I get more information and gain experience about what works and what is helpful when it comes to reimbursement, I will be sure to update this page.
