It seems tantalizing. If insurance companies covered doulas, everyone could have a doula and all the doulas would have thriving businesses….or would they? While I love the idea of expanded access to doulas, especially to the populations that can least afford it, let’s take a closer look at how insurance coverage might change things for doulas:
1. Currently, doulas set their own pricing, based on their expenses and allowing for income to support their families. With insurance companies involved, THEY set the “allowable” charge, and the doula’s expenses and income are NOT part of the process. You can trust the insurance companies to set the price as low as they can get away with – after all their goal is to have high profits to appease shareholders, not help women have good birth experiences. In Oregon, Medicaid has set doula allowable charges at $75. Not $75 an hour, $75 TOTAL. Minnesota is a little better, at $250. But neither of those covers my costs of doing business, so neither of those is a viable option for doulas to earn a living. Also note that accepting insurance reimbursement means you cannot under any circumstances bill the client for any balance over the allowable charges. So you’d be stuck taking the loss. Insurance coverage is NOT a pot of gold for the doula profession by any stretch of the imagination.
2. Currently doulas decide what is and is not included in their services. One prenatal, or two. Doulas can include more postpartum work, childbirth classes, a baby gift, a maternity massage, whatever works for them and makes their services unique. Insurance coverage would dictate what is included in the covered package and again, they’ll go for bare minimum. Keeping one prenatal will be lucky.
3. Currently, parents pay the doula directly, and the doula is only beholden to her client. With third party reimbursement, the doula is put in a spot where they have to try and appease both the parents AND the source of her income – the insurance company. This divided loyalty makes it harder for her to serve the clients well. We already know that the divided loyalty of hospital employed nurses acting as doulas reduced effectiveness.
Please note that there are CPT codes and diagnosis codes floating around the internet that some doulas have tried to use to get reimbursement. These codes are *medical* codes and using them for a doula’s non-medical services could be construed as insurance fraud. At one time, DONA International promoted the use of such codes and doulas getting an NPI number, but they have since pulled that as they have learned of the potential for doulas being prosecuted for insurance fraud for using those codes. I strongly recommend you not encourage your clients to use those for submitting insurance claims, or provide them with an invoice listing those codes. There are no appropriate codes for doula work, and given the significant opposition to establishing such codes, it is unlikely that any such code will ever be approved.
One of the biggest reasons that doulas are as effective as they are is the independence they have from “the system” and the undivided loyalty they have to their clients. I cannot imagine working as a doula under the restrictions and limitations of an insurance company. I would quit working as a doula before I would allow insurance companies to dictate how I could serve them. I don’t want them to have anything less than the best I can give, and I refuse to have my hands tied by a third party payer.