Doula & Insurance coverage

[Carita]

How do I go about getting reimbursement? I am being really hopeful perhaps, but I need the money!

any tips? Its a BCBS if that makes a difference and maternity is covered 100%

[April422]

Your doula should be able to help you wit this.
You need to submit the forms and hopefully a letter from your doula along with a receipt for what you paid her for her services.

[Carita]

any tips if/when they deny the claim?

[AlexisT]

I think you need to find out from your insurer whether doula services are covered. Many insurers do not cover doulas. If it's not a covered service, you have no real recourse.

Also, each BCBS plan is regulated by the issuing insurer--Highmark and CareFirst can have completely different policies even though they are both BCBS plans.

[chellebee]

Doulas certified through CAPPA and DONA (and perhaps others? These are the two I am sure about) can register to get their own code. This is fairly new, and many doulas do not have one. I have not heard of insurance actually covering services, but now that there is a code, you can still submit it and create demand for coverage, state your case in whatever approval process they may have, etc. If nothing else it can help push people getting coverage forward. If you have a flex plan, you can definitely submit it. Success of acceptance toward flex is pretty good.

[April422]

Originally Posted by Carita

any tips if/when they deny the claim?

They'll usually deny it, out of hand. I always encourage clients to appeal and I'm willing to write a supplemental letter outlining the ways in which I saved the insurance company money.

[AZgirl2207]

My BCBS excludes "childbirth education, labor support personnel, prenatal vitamins, support garments for pregnancy" etc. That being said, if it's not directly EXCLUDED...submit it. Worst case senario, you end up writing several letters and not getting paid. All you've wasted is a few $ on postage. There are some great posts on dealing with insurance over on the homebirth board.

[Carita]

all it says on the website is maternity prenatalpostpartum care and delivery covered 100%, but that services rendered outside may be subject to self-referred deductible