Flex Spending Accounts (FSAs) and Insurance
Did you know that you can use your Flexible Spending Account (FSA) to reimburse all or part of your doula expenses or that your insurance may help cover the cost of your doula care? Although getting your insurance to cover doula care can be complicated if you don't already have specified coverage for such services, my clients have had very few problems using their FSA. Insurance is a state's rights issue and California is not yet a place where getting reimbursement for doula services is easy or expected. It requires patience and persistence. Expect to be denied as insurance companies get accustomed to processing doula claims, but you can appeal that decision.
The Harmony Doula Group does offer payment plans and provides a detailed invoice of services, should your FSA require one. Because each insurance company has its own requirements, we are unable to file paperwork for you. There is no universally accepted code for doula services at this time.
Here is a checklist and some tips for getting reimbursed:
___ Pay your doula in full.
___ Get an invoice from your doula which includes the following information:
a. The doula's name and address
b. Doula's NPI number and/or taxpayer ID number
c. The date and location services were provided
d. Diagnosis code and taxonomy code.
e. The doula's signature
___ Submit the invoice with a claim form to your insurance company.
___ Within 4 weeks, expect a letter telling you either that
a. they need more information before they can process your claim
b. this is not a covered expense
___ If possible ask your doula to send you the following:
a. a copy of the doula's certification (if certified)
b. other credentials or relevant training
c. a letter detailing doula's training and experience and what doula did for you
___ If possible, ask your obstetrician or midwife for a letter explaining why a doula helped you, was necessary, or saved the insurance company money. (Did you have a high-risk pregnancy? Did the doula's suggestions appear to prevent complications or help your labor to progress more quickly? Did the doula's presence decrease your need for expensive pain medications?) I have heard of instances wherein care providers wrote a prescription for doula services. I do not have personal experience with that.
___ Write a letter explaining why you felt the need for a doula and how you believe the doula was beneficial to your health.
___ Submit to your insurance company:
a. the doula's letter and credentials
b. the letter from the doctor
c. your cover letter
___ If they refuse it, write a letter to Health Services requesting that they review the claim, as you feel it was a cost-cutting measure and they should cover the cost.
___ Follow up by telephone if necessary.
___ If they refuse, write a letter to the CEO explaining why you feel that doula care should be a covered expense. They may not pay your claim, but they will consider it for the future.
Excerpted from (c) Kelli Way, ICCE, CD(DONA) 1998 Permission granted to reproduce with complete attribution.