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!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.