 I just received an email from a doula friend notifying me that the Federal Government is compiling a list of "Essential Health Benefits" under the Affordable Health Care Act. These benefits are services that insurance companies would be responsible to cover by 2014. One of the categories listed is maternal and newborn care. Though doula care is not yet listed as an "Essential Health Benefit," we are working towards getting it there. Evidence based studies have proven that Doula care is preventative, cost-saving and habilitative, saving insurance companies thousands of dollars.Some insurance companies do reimburse doula services, if you know how to submit a proper claim. If you are using me as your doula, I can help you fill out the appropriate paperwork. If you are not using me as your doula, I have included step by step instructions on how to get your insurance company to reimburse you. (Found on the website www.theonlybabystop.com) 1. Pay your Doula First Your insurance company does not cover doula services; they may reimburse
you for the doula fee. This means you have to pay your doula first
before you can get reimbursement. Let
her know you’re asking your insurance company for reimbursement—she may
have tips to help you get it. 2. Get your Doula's Service Provider Code Taxonomy Code: #374J00000X. 3. Send in the Right Paperwork If your insurance company accepts your doula’s Taxonomy Code,
you will want to send it in along with a 1500 Universal Claims form.
You will need your doula’s invoice to do this. If you’re having
problems with your insurance company, DONA International suggests
sending in your doula’s invoice with a letter explaining what a doula
is and how they reduce costs. You may also need to include the proper diagnosis codes. This article from Gentle Birth.org
includes the most common codes for doula services. This article also
includes a sample invoice with the codes to help you out.
4. Expect Rejection Many couples are finding their insurance company initially
rejects the claim. You will have to resubmit it repeatedly, probably
with additional information. The good news is that more and more
people are getting insurance reimbursement—the more people who get it
the less time this process to likely to take. DONA has a sample letter
(click here to see) to send in to the insurance company if the initial claim is rejected. Hopefully this will soon be a thing of the past and all doula services will automatically be covered under maternity care. Until then, good luck and please let me know if you have any questions! Warmly, J |
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