How to get Reimbursed by your Insurance

For years, doulas have been working to get their services covered by insurance. We are getting closer every time someone submits a claim insurances are becoming more aware. One found that having a doula at your birth can lower the risk of costly interventions like c-sections and epidural anesthesia, lower the rate of NICU admittance, as well as increase the likelihood of spontaneous vaginal birth. The same study found that moms who have doulas at their birth have shorter labors and their babies are less likely to have low APGAR scores.baby

Stork & Sprout has had some clients be reimbursed anywhere from 60-100% With more parents attempting reimbursement, continued research and media coverage, we’re hopeful this process will start to change for the better.

In an NPR piece published recently about the study, entitled Doula Support For Pregnant Women Could Improve Care, Reduce Costs, author Tara Haelle writes:

This is the first study to show a reduction in preterm births and a net savings for public insurance. Cesarean births — about a third of all U.S. births — cost about twice as much as vaginal births, and the 1 in 10 U.S. infants born preterm (before 37 weeks) incur medical costs 10 times greater than those of full-term infants.

“What is coming together now is a research consensus and a professional consensus of the benefits of doula care,” said lead author Katy Kozhimannil, an associate professor in the University of Minnesota School of Public Health. “The barriers to access are financial, cultural and geographic. The financial barrier ought to be the first to fall.”

HERE’S WHERE TO START:
The following is a partial list of insurance companies who have reimbursed in whole or in part for doula services. (If your insurance company isn’t listed, it’s still worth attempting reimbursement. This list was first published in 1998, so policies may have changed.)

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

HOW TO REQUEST INSURANCE REIMBURSEMENT FOR DOULA SERVICES

  1. Pay Stork & Sprout in full.
  2. Get an invoice or Superbill from Stork & Sprout which includes the following information:
    1.  Stork & Sprout address
    2.  Attending doulas’ NPI number and Stork & Sprout Tax-ID
    3. The date and location services were provided
    4.  The CPT code for the services provided (99342 for Prenatal Support, 99499 for Birth Support 99502 for Postpartum Care)
    5.  A diagnosis code
    6.  The doula’s signature
  3. Submit the invoice with a claim form to your insurance company.
  4. Within 4 weeks, you may receive a letter telling you that either:
    1. They need more information before they can process your claim.
    2. This is not a covered expense.
  5. If possible, ask your obstetrician or midwife for a letter explaining why a doula helped you, was necessary, or saved the insurance company money (i.e. Did you have a high-risk pregnancy? Did the doula’s suggestions appear to prevent complications or help your labor to progress more quickly? Did the doula’s presence decrease your need for expensive pain medications?).
  6. Write a letter explaining why you felt the need for a doula and how you believe the doula was beneficial to your health.
  7. Submit to your insurance company:
    1. The letter from the doctor
    2. Your cover letter
    3. Abstract of 2012 update to the Cochrane Review study, Continuous support for women during childbirth.
    4. Abstract of 2016 Birthstudy, Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery.
  8. If they refuse it, write a letter to Health Services requesting that they review the claim, as you feel it was a cost-cutting measure and they should cover the cost. Include the abstract of both the 2012 update to the Cochrane Review study, Continuous support for women during childbirthand the 2016 Birthstudy, Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery.
  9. Follow up by telephone if necessary.

 

Sources:
Hodnett, E.D. Continuous support for women during childbirth. Cochrane Database System Review. 2012.
Kozhimannil , Katy B. Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery. Birth: Issues in Perinatal Care. Jan 14, 2016. Online.
Haelle, Tara. Doula Support For Pregnant Women Could Improve Care, Reduce Costs. NPR. Jan 15, 2016. Online.
Third Party Reimbursement Resources: Dona International.