Third Party Reimbursement for Doula Care

One of the significant benefits of having a doula at your birth works out great- not necessarily for you. Doulas reduce the amount of interventions that are implemented at births, overall, and increase resiliency and satisfaction with the birth experience. Who sees the benefit of this savings? Your insurance company!

Doulas have been working for years to be recognized by the insurance companies as a service worth paying for. The presence of a doula reduces the need for pain medication, allows laboring clients to go into the hospital later in labor, reducing the need for labor augmentation, and provide breastfeeding support during the recovery period, and so much more. It seems like a no-brainer that insurance would provide reimbursement for our services, and make it more accessible to families.

Reimbursement is spotty at best, but worth attempting. Parents can go through the process and find that they are fully reimbursed, partially reimbursed, or not reimbursed at all, and there’s no formula for us to know in advance what will happen.

First, know if your insurance company has provided reimbursement in the past. These companies have been known to reimburse for doula services at some level. It would be best for you to check with your insurance company, find out of they have reimbursed for doula care in the past and if not, how you might approach attempting it. The list below was gathered by

  • Aetna Healthcare
  • AltPro
  • Baylor Health Care System/WEB TPA
  • Blue Cross/Blue Shield
  • Blue Cross/Blue Sheild 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 & Annuity Ins. Co.
  • HNTB (Peoria, IL)
  • Houston New England Financial, Employee Benefits (Fort Scott, KS)
  • Humana Employer’s Health
  • Lutheran General Physician’s Organization
  • Maritime Life
  • Medical Mutual
  • Oschner HMO (Louisiana)
  • Professional Benefits Administrators
  • Prudential Healthcare
  • Qualchoice
  • Summit Management Services, Inc.
  • Traveler’s
  • United HealthCare of Georgia
  • United Health POS
  • Wausau Benefits

Second, it’s best if your doula is certified, and has a National Provider Identifier (Kristina does!), and you will need the CPT code to write on your reimbursement request. There is now a CPT code for both birth doula (99499), and postpartum doula services (99501 and/or 99502), respectively.

Third, it helps to have some personal statement about the benefits (to the insurance company) that having a doula brought to your birth. Did you have a vaginal birth? Perhaps having a doula helped you avoid a costly cesarean! Think about what will move the insurance company (hint… $$$), and speak to that. If your birth was complicated and by all rights, expensive, think about the benefits that doulas bring to births in general. Insurance companies want to save money and one client won’t be as impactful as how a service might a) benefit most clients, and b) save money at the same time.

Got all that? Certified doula with an NPI, the appropriate CPT codes for your paperwork, and the appropriate forms, and you have a chance of having some of your doula fees reimbursed by your insurance company.

We’ve made it easy with the Taproot Reimbursement Client Packet,  the tools you’ll need to request reimbursement. Even if you think there’s no chance, the more requests insurance companies receive, the more likely they might approve it in the future.

Best of luck!

When is it time to go?

One of the things that come up for our clients most often is the question about when it’s time to go to the birth space, or call their birth team in. 4-1-1 is a tool that many providers give their patients as a way to time contractions and ascertain whether they’re in active labor, usually the ideal time to head to the birth space. It’s a little trickier than that- let’s save you some fruitless, early runs to the hospital!

Signs you might be in labor

There are several signs that labor could be imminent. Oftentimes these signs are not recognizable as early labor signs, until after the birth when the parents look back over the birth story. “Oh, that funny feeling in my hips was probably contractions!” Looking back retroactively can answer a lot of questions. Here are just a few early signs that could be labor, or could be something else:

  • Contractions – I know you don’t want to hear that, but not all contractions are labor contractions. How to know if they’re worth noting? Notice over time if they are getting regular, longer, stronger, and closer together. Irregular contractions can indicate early, or practice (known in other circles as ‘false’) labor.
  • Loose and frequent bowel movements – Is it that potluck pasta salad, or is it labor? It’s hard to say. This is a common sign that labor could be starting, or it could legitimately be that flu that’s going around or something funky you ate. Notice it, but don’t let this get you anxious.
  • Loss of mucus plug – This interesting substance can make itself known any time in the last weeks of pregnancy. It’s constantly regenerating, so you can lose it, and then lose it again! It indicates that your cervix has started to change a bit, but does not indicate significant change all by itself. You can lose your plug before birth, or during your labor.

Other possible signs of labor can include: lightening, or the feeling that you baby has dropped, back ache, cramps, a feeling that something is different/off.

Signs that you are most likely in labor

You’ve moved through those nebulous possible signs, and now things seem a little more certain. Here are a few ways you can identify that you are indeed in early labor:

  • Regular contractions that are increasing in intensity and length, over time. It’s time to bust out that app you’ve been using to time the Braxton Hicks contractions you’ve been having, and put it to work! Measure contractions for an hour and then try to forget about it for a while. Measuring every contraction and symptom will just drive you crazy and won’t speed things up. Contractions shouldn’t go away no matter how you change your activity.
  • Rupture of membranes, or your water breaks. This is a definite sign that things are happening- but not a sign that you will definitely get contractions or birth quickly. Notice the color of the amniotic fluid; if it has a brown or greenish tinge, check with your provider, as this can mean that your baby has passed a bowel movement, which can indicate some stress. Having your water break is usually followed by contractions, or an increase in their intensity if you’re already having them.
  • Bloody show – Your cervix has to change from the consistency of the tip of your nose, to that of your lips, to the inside of your cheek. This means as it starts to soften and open, some of the blood vessels within it will break, and there will be blood tinged mucus released. It’s a good sign that your cervix is getting the labor message!

Some other signs that you are most likely in labor might be cramping, back pain, contractions becoming more painful, a sense of inner focus with contractions, dilation of cervix noted upon vaginal exam.

So, when is it time to go?

These symptoms can paint a nice picture of what might happen- and, the start of  your labor might not look anything like this. Maybe, like one of our clients, your contractions never get closer than 10 minutes apart the entire labor. Like another client, perhaps you don’t see bloody show until you’re near the end of your labor. It can be different for everyone, so try to notice what is happening, rather than what you expect to be happening.

Providers most often want their patients to arrive in the birth space right around the beginning of active labor. This video shows a nice progression of a woman who is in early labor, and then at the end, into transition (NSWF, breasts). Generally, providers recommend you to monitor their contractions and notice when they are four minutes apart, lasting a minute, for at least an hour, or 4-1-1.

The difficulty is that you might check all of these boxes, but still look like the laboring women at the beginning of the video. It’s still too soon to go, most likely. When your labor starts to look and feel more like the woman in the middle of the video, along with the regularity of contractions that are increasing in intensity and growing closer together, this is a better time to head to your birth space.

Okay, that makes sense… but.. when is it really time to go?

First, trust your instincts, and the information you’ve been provided about emergencies. Large gushes of blood, lack of fetal movement, these types of things can be emergencies and you should observe your providers recommendations around them. Sometimes people will just get a very strong feeling that it’s time to go, – not anxious, but very decisive, instinctual feeling- and we recommend you observe that, too.

Otherwise, we recommend that you consider going to your birth space when your labor pattern is regular and increasing (frequency, length of contractions and intensity), and when your coping is looking similar to the woman in the video, toward the middle. When you have turned more inward, have developed a coping ritual, need breathing or vocalizing to help you cope, and have started to become less self-conscious, it will likely be closer to active labor, and a great time to head to your birth space.