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How to Get Your Insurance Company to Pay For Midwifery or Doula

One of the big questions I get asked  is... if I hire a midwife or doula, will my insurance company cover her fees?  And if so, how do I go about it?  This is a very good question because as we all know, having a baby is not cheap.

 

What About Insurance?

Over twenty insurance companies have begun paying for doula services and, now that there is a CPT code covering services, this is more of a possibility than ever before. You will have to do research on whether your insurance company will cover a doula or not. 

 

I have my National Provider Identification (NPI) number which can be submitted to Medicare and third party insurance companies for reimbursement. I will create something called a superbill that you can provide to your insurance company. You would still have to pay me in full and then attempt to get reimbursement from the insurance company.  I can help guide you through the process.

Here is some good news. 

Insurance companies are finally recognizing that doulas can actually help lower costs thanks to a number of studies.  There was a fairly large study involving 15,288 women that found having a doula present at a woman's birth can shorten her labor time as well as lower the risk of costly interventions such as cesarean sections, instrumental usage and epidural anesthesia. Women allocated to continuous support were more likely to have a spontaneous vaginal birth.  They also found it was good for baby too. The study found that the babies were less likely to have low APGAR scores and lower rates of NICU admittance. 

I have found the most luck with clients being reimbursed or paying outright with their Health Savings Account (HSA) or Flexible Spending Account (FSA).

 

What you need to know!

There are twenty+  insurance companies that have begun paying for doula services. You will have to call your insurance company to see if they participate. And if they do you will have to find out if they'll cover all the expense or just part of it. 

There is a special CPT code (CPT stands for Current Procedural Terminology, and is a copyright of the American Medical Association) covering doula services. Here is the special CPT code:

  • (99499) Birth doula for Evaluation and Management Services/Labor Support.

  • (99501 and/or 99502) Postpartum doula services .

  • 59400: Antepartum, intrapartum, and postpartum patient care.

  • 99461: Initial home visit for newborn care.

  • 99461: Second home visit for newborn care.

Paying for Midwifery or Doula Support

There’s one thing we are a bit biased, midwifery and doula support is worth the investment. However, that investment can be a bit challenging for our clients. 

  • Midwifery, Doula, Massage Therapy, Maternal Health, Motherhood, Mothers, Placenta Encapsulation, Postpartum Doula, Pregnancy Support, Pregnancy, Postpartum Support, Wellness, Self Care

  • Depending on the benefits of your health insurance, there may be some help on the matter! We have found the most luck with clients being reimbursed or paying outright with their Health Savings Account (HSA) or Flexible Spending Account (FSA). 

Using Your HSA or FSA Account to Pay For Doula Support

  • Unfortunately, we have not found a health insurance plan that will outright pay for or reimburse someone for the cost of midwifery or doula support. However, I have had success with clients paying for our services with an HSA or FSA account. The IRS allows you to pay for midwifery or doula care out of your HSA or FSA account if your doctor agrees that the care is medically necessary to treat a medical condition (in this case, pregnancy and childbirth).

I

know, pregnancy and childbirth as a "medical condition"…but let’s just go with it. 

 

Reimbursement From HSA or FSA Account for Doula Payments 

If you would like to be reimbursed from your HSA or FSA, there are a few steps to follow:

  • Pay your doula support fee in full and receive an invoice stating the service and cost of the service

  • Fill out a Letter of Medical Necessity form. You can get this form directly from your HSA, or a generic one can be found online.

  • You will need to have your medical provider sign this affirming that you have the medical condition of being pregnant. 

  • File your invoice and Letter of Medical Necessity form with your HSA/FSA. This can usually be done online. It is recommended that you keep your paperwork in case you are ever audited. 

  • Enjoy your doula support that was reimbursed from your HSA or FSA!

  • While it sounds complicated, and a bit cumbersome to get your doctor to “diagnosis” you as pregnant, we will feel that it is worth it!

 

Using Your HSA/FSA Card to Directly Pay for Doula Support

If your plan permits you to pay directly with your HSA/FSA card, I accept those payments via my Square reader. Depending on your needs and funds available, we can set up a payment plan or send an invoice for the full amount. We will work with you based on your needs!

I accept payments in the form of; cash, credit card, zelle or venmo

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