While doula support may be seen as a luxury by many, it’s actually more accessible than you may believe! Many HSA and FSA plans cover doula care, and some insurance companies will reimburse you for doula fees. The HSA Store website states: “Doula services are eligible for reimbursement with flexible spending accounts (FSA), health savings accounts (HSA), and health reimbursement accounts (HRA) with a letter of medical necessity. They are not eligible for reimbursement with dependent care flexible spending accounts and limited care flexible spending accounts (LCFSA).”
It is always important to verify that your HSA plan does cover doula care, as well as provide a “letter of medical necessity” if required by your plan, signed by your care provider that specifically indicates the need for doula care. Think of this letter like a prescription. Filling it out is simple and straightforward. Once you’ve decided to hire a doula and found one that accepts HSA or FSA payments, you can take this form to your next prenatal appointment with your care provider and ask them to sign it. Then, submit it to your insurance company along with a detailed invoice provided by your doula. I’ll include a sample of the type of invoice needed.
In addition, it is often worth submitting an invoice and reimbursement form to your insurance company to seek reimbursement for your doula’s fee, even if you’re not sure they will approve the reimbursement. Unfortunately, this is never a guarantee unless your insurance company explicitly states that they cover doula fees. However, many insurance companies will reimburse you at least partially, and you can submit your claim multiple times. Look through this list of insurance companies that have reimbursed for doula services. For this, you’ll need a detailed invoice from the doula, and to include an insurance reimbursement form. DONA International provides a suitable one on page 8 of their Third Party Reimbursement Packet. Note that it includes Diagnosis V22.2 Intrauterine Pregnancy and CPT Code 99499 - both of which are essential for insurance billing.
If you participate in a health share rather than use traditional insurance, there is also the potential that your doula’s fee may be reimbursed! There are several health sharing organizations that will reimburse members for doula care. I am familiar with one that does for sure - Samaritan Ministries. To be reimbursed by a health share, submit the same documentation you would to an insurance company.
When choosing a doula, it is important to learn about how equipped they are to receive payments via HSA or FSA, or to provide adequate documentation for insurance reimbursement. Not every doula accepts HSA and FSA, and not every doula has an NPI, which is typically needed for insurance reimbursement. A note for doulas: you can obtain an NPI here if you don’t have one.
A final note: Indiana State Representative Maureen Bauer filed House Bill 1350 on January 13, 2021. This bill would require insurance companies to cover doula services, as well as require hospitals to allow doulas to be present at births in a professional capacity if the birthing person wants to have a doula. Learn more about this bill here.