Doulas covered by insurance?

[Banana731]

So, since there is now an insurance code for us... Has anyone had a client who has been able to get reimbursement for doula services?

[gentlespiritbirth]

I'm not familiar with a new code, but I've had at least one client get reimbursed by their insurance company.  It was eight or nine years ago and was with UnitedHealthcare.  (The only reason I remember that is because I had the same insurance at the time.)  I don't remember what code we used, but I know I wasn't the only doula at the time using that code or having success.  

[amymaew]

I don't know of a new code, but I've had success having clients reimbursed in the last year or so.

[Banana731]

http://www.dona.org/PDF/Third%20Party%20Reimbursement%20edoula%20090929.pdf

 So now, theoretically, we could even try to get reimbursed through insurance complanies and medicaid ourselves. I haven't applied for a provider number myself, I don't know if I will. But I was curious if it had become easier for clients seeking to do so on thier own after having doulas added to the "nursing" insurance code like that.

[amymaew]

Oh yeah - that's been around for about a year.  I have an NPI number and it seems to make it easier for clients to get reimbursed.  I don't bill insurance but instead provide a receipt with my npi # and cpt codes to my clients.  hth!

[phathui5]

Amy,

Can you share how much clients have been able to get from their insurance?

What codes do you use other than your NPI number?

[sweet.p]

Originally Posted by amymaew 

I don't know of a new code, but I've had success having clients reimbursed in the last year or so.

Hi Amy,

WOW, that is great.  I'm curious, do you know which health insurance company? You are sure it was from a HMO not their flex spending account?

Was this for postpartum or labor?

 Do you know how much they got back?

Sorry for all the questions,  but its been impossible for my clients to get reimbursed. 

If they have flex spending accounts, they are have always been able to withdraw money from that account with my invoice for postpartum doula care, but that's their own money in the tax free saving account with their employer. For flex spending withdrawls doula don't need to list any codes, just put your SS# or tax ID # on the invoice.

~~~~~

 These are the codes to use on an insurace form:

• the diagnosis code (V22.2, intrauterine pregnancy)
• the CPT code (99499, Evaluation and Management Services - Labor Support)

 Read more about them here:

http://www.gentlebirth.org/archives/sampleHCFA.html

~~~~~~~~~~~~~~~

This is the Doula Taxonomy code:

374J 00000 X - Doula

You use this doula code to apply for your NPI (National Provider Number), it only takes a few minutes on-line to apply, then they email it to you.

https://nppes.cms.hhs.gov/NPPES/SecurityCheck.do

~~~~~~~~~~~~~~

[amymaew]

I've had clients fully reimbursed for my fee ($650) fom Aetna.  They submitted through their health insurance coverage, not a flex spending.  I just got a call from BCBS about another client's claim, so I'm waiting to hear if it was approved or not.  I use the codes posted above.

[Banana731]

There is some good info coming up in this thread. Can this be made a sticky?

[sweet.p]

Originally Posted by amymaew 

I've had clients fully reimbursed for my fee ($650) fom Aetna.  They submitted through their health insurance coverage, not a flex spending.  I just got a call from BCBS about another client's claim, so I'm waiting to hear if it was approved or not.  I use the codes posted above.

Amy,  That is really fantastic for your clients.  It's not happening for my clients.

I'm assuming you're not a RN or hold any type of licenced credential, just a "doula".  

BC/BS has called me and asked if I was a RN. 

[amymaew]

Originally Posted by sweet.p 

Amy,  That is really fantastic for your clients.  It's not happening for my clients.

I'm assuming you're not a RN or hold any type of licenced credential, just a "doula".  

BC/BS has called me and asked if I was a RN. 

Yup I'm just a doula.  I'm certified through CBI, but that's it.  BCBS called to ask if I was in network, but they were clear that I was a doula and nothing else.  hth  :)

[thepeach80]

Amy,  That is really fantastic for your clients.  It's not happening for my clients.

I'm assuming you're not a RN or hold any type of licenced credential, just a "doula".  

BC/BS has called me and asked if I was a RN. 

Does it change something  if you're an RN?
 

[April422]

Originally Posted by thepeach80 

Amy,  That is really fantastic for your clients.  It's not happening for my clients.

I'm assuming you're not a RN or hold any type of licenced credential, just a "doula".  

BC/BS has called me and asked if I was a RN. 

Does it change something  if you're an RN?
 

For some insurance companies it means you're an out of network licensed healthcare provider and may make it easier to get reimbursement to your clients.  Depends on the insurance company and the state insurance laws.