At Bentonville Birth Services, we strongly believe that everyone deserves a doula.
We know everyone benefits from having individualized support throughout pregnancy, birth, and postpartum. We believe all people should have access to these services, regardless of their ability to pay.
Some insurance companies are starting to provide coverage or reimbursement for doula support as they realize it improves outcomes and saves them money. With decreased need for pain medication, reduced risk for cesarean section, prevented complications and shorter hospital stays, it benefits insurance companies to invest in doula care for their subscribers.
We strongly encourage you to seek coverage and/or reimbursement for doula support!
The more consumers request this kind of care, the more providers and institutions will take note and respond to consumer demand. Below we have laid out steps you can take to request coverage for birth and postpartum doula support — even if if’s not currently listed as a benefit with your insurance company.
Step 1: Obtain a Letter of Medical Necessity
A Letter of Medical Necessity (LMN) explains why doula services are medically necessary/beneficial for your unique situation. Ask your healthcare provider(s) for a Letter of Medical Necessity (LMN) explaining why a doula was beneficial, necessary, and how doula support saved the insurance company money. Your letter should be compelling: showcasing the crucial role doula support played in your well-being.
Pro Tip: Make it personal. Share anecdotes, fears, and aspirations with your healthcare provider. The more they connect with your story, the more heartfelt and persuasive your LMN becomes.
Your insurance company may have a specific form for this, so be sure to ask when calling to verify benefits. Be prepared to be told “no” up front, as doula services often aren’t known or listed by name. Do not be deterred. We still recommend submitting a Letter of Medical Necessity (LMN) in addition to whichever form(s) your insurance company requires.
Even better – write your own LMN and bring it to your healthcare provider to sign!
Providers are far more likely to give their recommendation with a simple signature rather than setting aside the time amid their busy schedule to draft a letter of their own. We have a sample letter of medical necessity that you are welcome and encouraged to use for inspiration in crafting your own LMN.
Sample Letter of Medical Necessity (feel free to copy into a doc and edit for your specific situation)
[Health Care Provider’s Name]
[HCP’s Address]
[HCP’s Email Address]
[HCP’s Phone Number]
[Date]
[Insurance Company Name]
[Claims Department]
[Address]
Re: [Your (Patient's) Full Name] [Date of Birth] [Policy Number]
Dear [Insurance Company Name],
I am writing to request coverage for doula services for my patient, [Patient's Full Name]. I am [HCP’s Name], a licensed healthcare provider and the attending [Specialty] responsible for the care of the patient. Patient [Patient's Full Name] is currently under my care for [Medical Condition/Diagnosis] and has been recommended to receive doula services as part of their comprehensive medical care plan. The utilization of a doula is deemed medically necessary to address and support the unique physical and emotional needs of the patient during pregnancy, labor, and postpartum.
[Doula's Full Name], the certified doula recommended for this service, is highly experienced and trained to provide emotional and physical support to expectant mothers. The role of the doula in this case is crucial for the well-being of the patient, as it has been shown to have positive effects on maternal and neonatal outcomes.
The following factors contribute to the medical necessity of doula services for this patient:
• [Specify any relevant medical history or complications] (See list of reasons below)
• [Detail how doula services will complement the overall treatment plan in your specific case]
(See list below)
• [Highlight any research or studies supporting the benefits of doula services in similar cases]
(See list of links below)
I am requesting that you consider coverage for doula services as an essential component of the patient's medical care. The provision of doula services is consistent with the standard of care for patients with [Medical Condition/Diagnosis], and the positive impact on patient outcomes is well-documented.
Enclosed with this letter, you will find supporting documentation, including medical records, relevant literature, and the doula's certification/training credentials. I am available for any additional information or clarification you may require.
Thank you for your prompt attention to this matter. I look forward to a favorable response.
Sincerely,
[Health Care Provider’s Name]
[Your Title]
[Your License Number]
[Your Signature, if sending a hard copy]
___________________________________________________________________________
List of Reasons for Medical Necessity
• High-risk pregnancy
• Expecting twins/multiples
• A history of anxiety and/or depression that puts me at higher risk for postpartum mood disorders
• A history of trauma that makes me more likely to experience and suffer from birth trauma, and have a complicated delivery and postpartum recovery
• Wanting a low-intervention birth without expensive pain medication
• Being Black/Indigenous Person of Color, especially living in Arkansas, which has the highest maternal mortality rate in the country.
• Gestational Diabetes / Pre-eclampsia
• High Blood Pressure
• Preparing to have a VBAC (Vaginal Birth After Cesarean)
List of Ways Doula Support Complements the Treatment Plan/Benefit the Patient
Benefits of doula care include:
• Fewer c-sections (cesarean sections) for current pregnancy, which also means fewer cesareans in future pregnancies
• Less anxiety and depression for pregnant people
• Less expensive pain-relief medications requested and utilized during labor
• Shorter time in labor
• Fewer negative childbirth experiences
• Better communication between pregnant people and their health care providers
• Lower rates of preterm births, which translates to less time in the NICU, if any
• Lower healthcare costs
Research Supporting the Impact of Doula Support (choose a few that best support your case)
➢ The Evidence on Doulas, by Evidence Based Birth: https://evidencebasedbirth.com/the-evidence-for-doulas/
➢ The Cochrane Review on Continuous Support for Women During Childbirth: https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
➢ “Modeling The Cost Effectiveness of Doula Care Associated With Reductions In Preterm Birth And Cesarean Delivery” from The National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544530/
➢ The Impact of Doulas on Healthy Birth Outcomes, by the National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
➢ The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review, by the National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/
➢ “Doula Care Improves Health Outcomes, Reduces Racial Disparities, and Cuts Cost” from the National Health Law Program: https://healthlaw.org/doula-care-improves-health-outcomes-reduces-racial-disparities-and-cuts-cost/
➢ “Doula Care and Maternal Health: An Evidence Review” – an Issue Brief from the Department of Health and Human Services: https://aspe.hhs.gov/sites/default/files/document/dfcd768f1caf6fabf3d281f762e8d068/ASPE-Doula-Issue-Brief-12-13-22.pdf
➢ “Doula Support Improves Maternal and Child Health Outcomes, Patient and Family Engagement” by the National Institute for Children’s Health Quality: https://nichq.org/insight/doula-support-improves-maternal-and-child-health-outcomes-patient-and-family-engagement
➢ “Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries” from the National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617571/
➢ “Modeling The Cost Effectiveness of Doula Care Associated With Reductions In Preterm Birth And Cesarean Delivery” from the National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544530/
➢ “Private Insurance Coverage of Doula Care: A Growing Movement to Expand Access” from the National Health Law Program: https://healthlaw.org/private-insurance-coverage-of-doula-care-a-growing-movement-to-expand-access-2/
➢ “Doula Care Saves Lives, Improves Equity, And Empowers Mothers. State Medicaid Programs Should Pay For It” from the Health Affairs Forefront: https://www.healthaffairs.org/content/forefront/doula-care-saves-lives-improves-equity-and-empowers-mothers-state-medicaid-programs
➢ “Doulas and Midwives Are Key Partners in Improving Maternal and Infant Health Outcomes” from the National Academy for State Health Policy: https://nashp.org/doulas-and-midwives-are-key-partners-in-improving-maternal-and-infant-health-outcomes/
➢ “Study Shows Doula Care Is Cost-Effective, Associated With Reduction In Preterm And Cesarean Births” from the University of Minnesota’s School of Public Health: https://www.sph.umn.edu/news/study-shows-doula-care-is-cost-effective-associated-with-reduction-in-preterm-and-cesarean-births/
➢ “Maternal Health Advocates Urge Insurers To Cover Costs Of Birth Doulas” by Illinois Public Media: https://will.illinois.edu/news/story/maternal-health-advocates-urge-insurers-to-cover-costs-of-birth-doulas
➢ “New Penn Research Eyes Closer Integration of Doulas and Hospital Maternity Care: Non-Medical Birth Support Workers Gain Traction in Maternal Mortality Crisis” by the Leonard Davis Institute of Health Economics: https://ldi.upenn.edu/our-work/research-updates/new-penn-research-eyes-closer-integration-of-doulas-and-hospital-maternity-care/
➢ “Health Plans Should Consider Paying for Doula Services, by the American Journal of Managed Care: https://www.ajmc.com/view/removing-financial-barriers-to-evidence-based-maternal-support-health-plans-should-consider-paying-for-doula-services
➢ “Covering Doula Services Under Medicaid: Design and Implementation Considerations for Promoting Access and Health Equity” by the Center for Health Care Strategies: https://www.chcs.org/resource/covering-doula-services-under-medicaid-design-and-implementation-considerations-for-promoting-access-and-health-equity/
Step 2
Include any relevant medical information supporting what your healthcare provider mentioned in the Letter of Medical Necessity.
Step 3
Ask your doula (Bentonville Birth Services) to provide you with a letter detailing the extent of their support for you, including their NPI number and any relevant CPT codes. An itemized receipt will often help as supportive documentation for your insurance company.
Step 4
Follow up with your insurance company to ensure that they received all your documentation, and that they are considering your claim.
Step 5
Please let us know the outcome of your efforts! It always helps us to collect more information and understand how we can help families get these services covered!