Monday, December 5, 2011

Reimbursement for Doula Services

I recently attended webinar on how a doula can set things up so that her clients can submit a request to their insurance company to be reimbursed for doula services!

If you are a member of DONA you can download their Third Party Reimbursement packet for more information. I really enjoyed the webinar, though, because it explained to me face-to-face how to go about something like this. It made it seem a lot less daunting!

First, a doula needs to obtain an NPI at https://nppes.cms.hhs.gov. The taxonomy code actually falls under Nursing Service Related Providers type 374J00000X. NPI is only referring to doula work. The doula must also have a Tax ID#, or use their SSN.

The doula can help a client fill out a form with their health insurance company. If the insurance co does not have a form, a universal 1500 form can be used. The code for birth doulas is CPT 59400. A diagnosis code is required - V22.2 Intrauterine Pregnancy

When submitting it is also beneficial to include:  A letter from the client, a description of a doula, the DONA International position paper, Standard of Practice, and Code of Ethics. Additionally, details such as the number of client meetings, number of hours in labor, and exact services provided should be included along with your certification credentials, if any.  A letter from a provider about the benefits of a doula is a plus; more likely to be reimbursed if you can show that your services helped lower costs for the insurance company! For instance, helping a mom to not require an epidural or end up with a cesarean section is a big money saver! 

At the moment, no company is paying consistently, and none have been covered by Medicaid. Some states do have grant money for doula coverage, so look for those!

Remember: the doula does not submit the forms, the clients do. Clients pay the doula in full and then submit request to the insurance company to be reimbursed. Claim submissions can be submitted multiple times up to 12 months after the birth. 

Has anyone successfully been reimbursed for doula services? Share your story!


In the DONA packet on Third Party Reimbursement they include an interesting section that I am going to include here as food for thought:


Concerns about third party reimbursement The Third Party Reimbursement Committee will continue to gather information about the potential consequences and challenges to third party reimbursement. At first glance, it may seem to have no drawbacks. However, realistic assessments reveal that third party reimbursement may have costs that are not immediately apparent. The following concerns have been raised.  
1. Will the reimbursement for doula services paid by third party payers be too low? Will it force doulas to reduce the fees they normally charge for private, self-paying clients? While doulas would not necessarily be required to accept low reimbursements or require clients to make up the difference between reimbursement and the actual fee, it is possible that financial pressure would cause doulas to consider lowering their fees.
2. What restrictions or responsibilities might be added to the doula’s role by third party payers (e.g., licensing by the state, longer training, proficiency exams, different certification requirements or additional health care training or licensing)? Would doulas be required to carry malpractice insurance and would that make them more likely subjects of lawsuits?
3. What conditions or requirements might be placed on the consumer in order that her doula’s services will be reimbursed? At least one third party payer has already limited the consumer’s options by covering the cost of birth doula services only if the woman agrees to not request an epidural. Birth doulas cannot be put into a position of preventing women from having an epidural or of supporting only particular choices.  
It is possible that, if reimbursement were available only for doulas with state licenses, doulas could choose not to seek reimbursement and could remain unlicensed. It is also a remote possibility that it might become illegal for unlicensed doulas to practice in some states. Some hospitals might require certification to support women in their facilities. The benefits of regulation must be balanced against the loss of freedom it entails. 

If you are looking for liability insurance - CMF Group has the cheapest (called "postpartum" services)

2 comments:

  1. Thanks so much for your sharing what you learned!

    ReplyDelete
  2. I am sorry, but this is incorrect. The CPT code 59400 is for prenatal, intrapartum and postpartum clinical care, ie "delivering" the baby, used by midwives and physicians. Apparently, according to many other sites, the correct CPT code is 99499.

    ReplyDelete

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