Insurance Reimbursement

[fearlessbirth]

Do doulas qualify for this? I mean, I'm sure it depends on your plan but is it even heard of?

Does any one know if whatever the insurance the military has covers us?

Thanks!

[DL]

I have heard that a few doulas have had insurance reimbursement in the past, but I've also heard that it's pretty rare. Most insurance companies don't. It can never hurt to try, though, if you and your client desire to submit a claim. They will most likely decline it, but you can send in an appeal along with a letter of what you did for the client the second (and third?) time around, as well as how much money you saved the insurance company (if low or no intervention birth). The parents can write a letter, too. Who knows? It might work this time around! To be honest, if more doulas did submit for insurance more often, then the insurance companies would probably be more likely to accept us as professionals and start accepting claims for our services.

UPDATE: This post has been edited by me, deleting some incorrect information. Doula Office 2.2 does NOT have insurance claim forms like I had thought. If I have misguided anyone into making purchases of Doula Office 2.2 solely for this purpose, I apologize...I am so sorry. Please see post # 6 in this thread.

[DL]

I don't know about the insurance companies that cover the military, but I would assume it would be much the same procedure as far as submitting claims. If I remember correctly, Raspberrymoondoula (Lynn's) dh is in the Navy, so maybe she knows. ??

[DL]

Sorry, I'm having trouble with linking to the thread that mentions Doula Office. I've not had problems linking to threads in the past, so I'll have to investigate to see what I'm doing wrong.

In the meantime, if you're interested: Do a search for: business software. You'll find it listed there--post #3.
------------------

UPDATE: I have since figured it out, and the link in my first post is now working!

[fearlessbirth]

Thank you so much!

[DL]

Quote:

Originally Posted by fearlessbirth Thank you so much!

fearlessbirth.....I am sooooo embarrassed. After all that effort to post info on this, ...and then you thanking me!....I JUST realized that I am sorely mistaken. After going through my Doula Office, I saw that the Insurance Reimbursement form is NOT in Doula Office 2.2 as I REALLY thought I had remembered!!! If anyone has purchased Doula Office solely for this purpose.....I apologize with all my heart. Doula Office does have many useful things/forms, so it wouldn't be a total waste of money, but I'm so sorry that I have inadvertantly misguided folks on this one. I do have the Insurance form in an Adobe Reader pdf doc on my computer, so PM me if you want me to send you the file via email. I will edit to delete the incorrect portion of my above post. I really hope that my edit will be done before anyone purchases it for THIS reason.

fearlessbirth....I will contact you via PM and/or email right away in addition to this post. Please forgive me, I'm sorry!!!!

[AussieDoula]

I think that having insurance cover Doula (both birth and postpartum) services is still largely unheard of, although there are a few things you can do to help bring the benefits of a Doula into the spotlight more.
One of them is having your clients care provider write a "prescription" for Doula services. A basic outline would be something like this one:

Physician's "Prescription" for Doula Care
(Client name) is under my care for pregnancy, due on or about (due date).
This will be her first baby. Pregnancy has been uncomplicated. [Or list complications - VBAC, previous vacuum extraction, epidural, whatever]
I have advised her to engage a professional birth assistant for home care before and after the birth and for labor support in the hospital.
I have recommended (Doula's name here), who is a professional childbirth assistant and a (Licensed Midwife/Lactation Consultant/Childbirth Educator/whatever additional credentials you have).
I feel that this support is medically necessary because of her desire to have a non-medicated birth and because of limited nursing support in the hospital.

Ideally, you should ALWAYS have your client file with their insurance company (and appeal if the claim is denied). Even if they don't cover Doula services, these letters are so very important in setting precedents and after having several filed, an insurance company may look into the statistical benefits of having a Doula and how much money they can save. I would encourage you all to start recommending this to your clients!

[jesscardona]

we still love you Lori...

[newbirth]

Always remember that a denial is not the last word. Most insurance companies make a habit of denying claims the first time around. If an appeal is never filed, then they don't have to pay. I've never filed to have a doula covered (was going to, but its a long story why I didn't), but I have had two midwife-attended home births with unlicensed providers covered by two different insurance companies. One we had to file an appeal and keep on top of the company, but they eventually paid...about 9 months later. I imagine the same thing is true for doulas. You need to know the correct coding numbers and use the right forms. This can make all the difference in the world. Ollie Hamilton at birthwithlove.com has a part of her website devoted to the claim form numbers. Find the numbers for birth/labor support. If you look like you know what you're doing, even if you don't, you're more likely to get coverage. There are also individuals out there that have made a business of submitting insurance claims for midwives, and perhaps other professionals. It might be worth looking into. Good Luck!

[motherstouchdoula]

Just got a call if I take insurance..umm do I?? I told her to call her ins company and see if Doulas are covered and if not we could do a payment plan that would work for her and her needs..

So does ins cover us?? If so do I have to have my Cert? (I don't yet but should here in about a month or 2)

HELP!!!

[jesscardona]

what I've heard and read is NOPE!
even in my flex-cafeteria plan there is no reimbursment for doulas!

[fearlessbirth]

Hey! Who are you trained through? I know DONA has a complete form for insurance reimbursement (complete with correct insurance code and everything). You may be able to something similar. I don't think you have to be certified but some insurance companies may require a letter of recommendation (like an Rx for a doula) from her MW/OB.

[motherstouchdoula]

I am trained through Dona, and i have seen the 3rd party remibursements before. I am just not 100% sure if ins would cover doulas or not, has anyone had sucess with billing ins?

[fearlessbirth]

I've not had any success but haven't tried I should have though..even if I didn't get money it would be one more request for them to consider and bring doulas to light!

You could always try it. Is her hiring you dependent on whether or not her insurance would cover it? The only way to know for sure is for her to call her own insurance company and find out. It varies from policy to policy. And give her the labor support code # off your 3rd party reimbursement form.

[AussieDoula]

You should always aim to have mamas file for reimbursement, regardless of whether their insurance states they cover it or not. This is the only way to make companies aware of Doulas, and possibly even interest them into doing research into how much money they can save by reimbursing Doula work.
I try and keep a list of carriers that have covered Doula services for reimbursement. It is taken from Debbie Young's list, and I like to give the list to all my mamas because even if their insurance company isn't listed, they can still submit it and use it when they file (so that their insurance company understands fully that MANY of their competing agencies already cover Doula services).

Insurance Carriers That Have Reimbursed Members for Certified Doula Services - Debbie Young, CD (DONA)
3rd Party Reimbursement Chairperson
805 Washington Ave.
PO Box 336
Lowden, IA 52255

• Oschner HMO, Louisiana
• Aetna Healthcare
• Travelers
• Fortis Insurance
• Qualchoice
• Blue Cross/ Blue Shield PPO
• Blue Cross/Blue Shield
• Cigna
• Foundation for Medical Care
• AltPro
• Wausau Benefits, Inc
• Professional Benefits Administrators
• Humana Employers Health
• Glencare Managed Health Inc.
• Summit Management Services, Inc
• Lutheran General Physician's Organization
• Elmcare, LLC, C/O North American Medical Management
• Prudential Healthcare
• Great-West Life & Annuity Ins. Co.
• United HealthCare of Georgia (San Antonio, TX)
• HNTB, Peoria, IL
• Houston New England Financial, Employee Benefits, Fort Scott, KS
• Maritime Life
• Degussa, a German Chemical Company
• Baylor Health Care System/WEB TPA
• Medical Mutual
• United Health POS

This list continues to grow. If your Insurance Company is not listed above, you may want to write to the CEO and ask "why not"?

DONA and third party reimbursement.
DONA's Doula Sample Letter for Insurance Reimbursement.
Gentle Birth's Reimbursement Codes.
More of Gentle Birth's info about Doula reimbursement.
Postpartum Doula Reimbursement (scroll down).
Printable Doula Form.

Physician's "Prescription" for Doula Care:

Quote:

(Client's name) is under my care for pregnancy, due on or about (due date). This will be her (first/second/whatever) baby. Pregnancy has been uncomplicated (or list complications - VBAC, previous vacuum extraction, epidural, whatever). I have advised her to engage a professional birth assistant for home care before and after the birth and for labour support in the hospital. I have recommended (Doula's name here), who is a professional childbirth assistant and a (licensed/trained/certified Midwife/Lactation Consultant/Childbirth Educator/Birth Doula or any additional credentials you have). I feel that this support is medically necesssary because of her desire to have an unmedicated birth and because of limited nursing support in the hospital.

This particular "prescription" can be adapted for Postpartum Care also.

Debra Pascali (DONA) has had 16 different insurance companies cover her work as a doula.

Give your mamas an invoice to submit to their insurance carrier. Chances are it will be turned down automatically, but tell your mamas to be persistant! They may need to submit the request two or three times until it actually reaches someone who can make the decision.
Persistance is key!!
Make sure mamas file the correct forms for insurance, it will help process faster (and no-one will be accountable for filing incorrectly - which I believe is actually a crime ?not sure?), and good luck!