Doulas Covered by insurance!!!

A friend posted this article on BabyOhm about Doulas being covered by insurance. i am so excited to hear this!!! Its a great benefit to moms wanting doulas at their births but who can’t afford it, nor can they find a finance friendly doula. Exciting for me in both sides, financial help to my clients and insurance coverage for my doula, pretty sweet deal to me!!!!

Anyway here are the details as posted from DONA International’s eDoula special announcement dated September 29, 2009, found here. (PDF Link!)

DONA International is pleased to announce that a new code for doulas in the United States has been approved and defined by the National Uniform Claim Committee. This code will come into effect on October 1, 2009 for services rendered after that date. Pat Burrell, a birth doula and registered nurse from South Carolina, was successful in lobbying for the assignment of the code, which will allow doulas to be assigned provider numbers to submit claims to both Medicaid and third-party payers for their services.

“While this does not guarantee third-party reimbursement, it is an enormous step forward in our mission to ensure a doula for every woman who wants one” says Debbie Young, President of DONA International. “Individual doulas will have to apply for a provider number and comply with other requirements that have yet to be determined. Regardless, we are excited to announce Ms. Burrell’s success with this initiative, which will benefit thousands of women and families for years to come. This is an exciting day in childbirth in the United States.” For further information, please contact Jessica Atkins, DONA Third Party Reimbursement Chair or  Stefanie Antunes, Director of Public Relations.

Insurance Claim Code Q & A

Q: What is a taxonomy code?
A: The National Uniform Claim Committee (NUCC) is the association which defines and assigns code numbers that can be used by provider groups and individuals to obtain a National Provider Identification (NPI) number. The NPI is used in conjunction with the taxonomy code to submit claims forms for reimbursement through third party providers such as insurance companies.

Q: How can a doula get a provider number?
A: Doulas must file for an NPI number through National Plan and Provider Enumerator Systems (NPPES). They will need the taxonomy code to do so. Access the NPI Application Instructions here.

Q: Can a doula group apply?
A: Yes, a doula group can apply but it is suggested by the NPPES that individual doulas apply for their own NPI code.

Q: What will doulas need to do to apply for reimbursement?
A: Doulas will need to obtain a provider number. We are unclear at this time if there will be minimum certification or training requirements or what other steps might be required. Doulas will need to complete and submit a 1500 Universal Claims form, which can be ordered on-line or picked up at most medical supply stores.

Q: What is the Health Care Provider Taxonomy Code that we are talking about?
A: It is a number 374J00000X. It is called “doula” and falls under the “Nursing Services Related Provider” section.

Q: Will doulas need to be nurses to qualify as a provider?
A: No, doulas do not need to be nurses to qualify. We believe all doulas will be able to apply for a provider code, but more information will be available in October when the code comes into effect.

Q: Does this guarantee reimbursement for my clients?
A: No, this does not guarantee reimbursement, but all parties should be considering it equally. The need for a taxonomy code and a NPI number has been an impediment to reimbursement in the past. DONA International recommends that doulas use appropriate caution as it remains unclear how, who, and what amounts will be covered. We encourage you to ensure a contract outlines all expectations and fee structures in the event that services are not covered.

Q: How much can I expect to bill for birth or postpartum doula services?
A: We do not know the requisite standards at this time.

Q: How can clients get reimbursed for doula services?
A: Clients can still file for reimbursement through their insurance providers.

Q: How does a doula get paid for providing services to Medicaid recipients?
A: The doula must apply to become a provider through her state administered Medicaid provider system. This varies from state to state. The Taxonomy code and NPI may help facilitate this process. Most of the provider application processes are posted on the state websites

Q: Is this just for birth doula services?
A: No, the doula code includes professionals who “provide physical, emotional, and informational support to a mother before, during, and just after birth and/or provide emotional and practical support to a mother during the postpartum period.” The code appears to apply to both birth and postpartum doula services equally.


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