Does My Insurance Pay for Doulas?

Will Insurance pay for a doula?

The answer here isn’t black or white, but rather….it depends.

YES-More and more insurance companies including TriCare and Medicaid (state specific) are beginning to cover or reimburse doula fees, while other companies like Carrot Fertility are actively in support of birthing families and their entire journey from TTC (trying to conceive) through the first 6 weeks after baby arrives.

NO- There are still many, if not most insurance companies that do not understand the benefits of doula support, or simply do not offer coverage for anything outside of the birth process or those that are mandated by law.

Knowing where your insurance stands before reaching out to doulas and looking for coverage is the first step. 
As an example, we are not medical providers and do not provide medical billing or CPT codes for our services. These codes are nursing codes, and cannot be used for doula services. The following code (99499) is not a code for doula services. It is to be used by physicians, “(or other health care professional)” only. If your insurance is requesting this, please refer them to the above link and let them know that while we are happy to provide an NPI # for your doula, and a detailed invoice, we cannot legally use a medical code for evaluation and management of labor as we are not medical providers.

Using an HSA, FSA, or Fertility Care Plan is the Easiest Option

If your employer offers a savings or fertility plan option as part of your insurance coverage, many will offer flexible spending options to cover a variety of non-typical care.

These services are designed to reimburse you for the money you spend out of pocket for things not otherwise covered under your regular health insurance policy.

You decide the service(s) you would like and pay the invoice, then submit it to the company. They reimburse you for a portion of the services, within the limits of their individual coverage.

In the last 6 months, we have seen an increase in families receiving reimbursement through Carrot Fertility, which covers both birth and postpartum doulas, allowing families to choose how they spend their benefits, including fertility treatments, adoption, and surrogacy

Medicaid and TriCare offer Limited Options

While there are a limited number of states covering doulas under Medicaid, Colorado is still working on this process.

TriCare does offer reimbursement and direct pay to doulas, however, the requirements for both families and doulas are quite restrictive, currently limiting the number of families who can receive these services, and the number of doulas who can qualify to provide these services. We hope that these issues will be addressed in the future, allowing more doulas to be able to offer these services in a sustainable way. Use this Link to Find a TriCare Doula Near You.

Does TriCare cover doulas? Does Medicaid cover Doulas?

How to Get Doulas Covered By Insurance 

We always tell clients that THEY drive the industry. While the majority of our clients do not use any type of insurance benefits to pay for our services, we alwasy recommend that they reach out to their employer and insurance provider to check for doula coverage and/or to request that coverage. The more families who do this, the more these benefits will become the norm for all.

To use the benefits you do have for doula services, we recommend the following steps to make it as seamless as possible.

  • Make sure prospective doulas know this is your intention from the beginning. 
    • Some doulas may choose not to work with insurance
    • Others may not qualify based on your provider’s requirements
    • Understanding insurance invoicing requirements and using a professional invoicing system will make the process much easier and prevent issues with reimbursement
  • Plan ahead. Getting approval for your doula, processing paperwork, and receiving reimbursement can take several weeks
    • Busy doulas book well in advance and waiting until the last few months could mean qualifying doulas are no longer available
  • Be prepared to pay upfront
    • Paying your retainer reserves your spot on the doulas’ calendar, giving you more time to complete the process and receive funds from your company
  • Work with an established agency
    • Agencies have a large pool of doulas to choose from and are able to match you with qualified doulas quickly
    • We can handle the logistics for you, saving you time and allowing you to focus on other things
    • We have experience working with multiple insurance companies and can easily adjust our systems to accommodate their requirements
Carrot Fertility covers doulas

We’re Here to Help!

Colorado Mountain Doulas has been connecting families with professional doulas since 2015. We have the experience, knowledge, and administrative systems to easily work with all types of insurance reimbursement. We are available to speak directly with your providers to discuss their specific requirements, and we have a large team of doulas ready to support your family across the state of Colorado. Feel free to contact us with more questions.

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