Getting Insurance to Pay for Doula

[willsmom]

I have cigna health and I have tried to get them to pay for some portion of my doula's fees. I sent them a letter from my midwife and a letter from myself pointing out the benefits of having a doula. I just received word that their consultant (read medico, probably) rejected my claim for coverage, but I will have a chance to appeal. Anyone out there have success with getting their doula's fee paid for by their insurance company...cigna in particular.

Thanks,

Daphne

P.S.: I will definitely appeal their decision especially if I save them a bundle having a vbac rather than an erc.

[Emmalee's Mom]

Hey Daphne, I also have cigna, and do not understand why they don't offer these services to women who don't want repeat c-sections. They obviously aren't concerned with saving money or well mental being when it comes to women's services.

This angers me because I am planning a VBAC delivery, which my doctor is supporting me on, however, because of the so-called risk to uterine rupture, we are both not allowed to deliver anywhere else except in a high risk trauma rated hospital. There they have midwifery directly located on hospital site, but because I'm not under the insurance company they use, I'm not considered to use them to my benifit under cigna, who is my carrier.

I have found several certified doulas through DONA, and would love to use their services but currently very strained budgetwise as my husband is currently unemployed and I'm the only breadwinner.

I'd be interested in what comes out of your appeal. I'll be watching for your update and this thread! :)

[SJane]

Sometimes if your doula can find insurance codes that match up close enough to services that are covered, then you can pull it off, but it's pretty rare. You can get the codes from your insurances customer services usually. I don't have any experiences with it working... but it's always worth a try and also helps out the doula community by enlighting more insurance companies!!
Also, you can see if there are any doulas still in training in your area who might still be needing to do some volunteer work!

[artgirl]

I don't have Cigna insurance but I'm planning on using a doula for my delivery in August. I am definitely going to try and have the expenses reimbursed. The woman from the insurance company that I talked to said that it's a good idea to back your claim up with research. DONA provides some on the internet but does anyone else out there know of any studies that I can quote that outline the benefits of using a doula. Statistics... I need positive statistics...

If anyone has been successful in this way please give me some pointers.
Thanks!

[gauge14iv]

Ask them for a copy in writing of the criteria they are using to deny your claim. If it isn't within the criteria in the book, they deny it unless you can prove medical necessity. You might also ask for a nurse case manager to be assigned as claims are frequently denied by someone who has more insurance experience than medical experience, and if that doesn't get you anywhere, you can ask to have a physician review your case (a physician who works for Cigna however) If you go for NCM or medical review, you will need to provide supporting documentation as to why a doula is medically necessary. If you can't prove medical necessity, there there is no way they will pay the claim (nor should they)

Of course they don't care about individuals health! They are in business to make and keep money! If they weren't they'd be out of business rapidly. But they are just like any other big business...

I used to be an NCM there - if you need help, let me know.

[Allana]

For research, check out the book Mothering the Mother by Marshall Klaus, John Kennell and Phyllis Klaus. There are specific studies listed in the book on why a doula is so benificial. I also say to find out if there are any new doula's in your area who are needing births for certification. They usually don't charge or just ask for a donation to cover thier expenses. There may also be more info in Henci Goer's book, The Thinking Woman's Guide to a Better Birth. Good luck!

Allana