How to Get Reimbursed for a Doula: Insurance, HSA and FSA

You paid the doula, or you are about to, and you want some of it back

Maybe you signed with a doula and a friend said, "Submit it to insurance." Or you have money in an HSA or FSA and wonder if it counts. Getting reimbursed is often possible, but it depends on your plan, and the paperwork matters as much as the rules.

This guide is the step-by-step version. For the big picture of every way to pay, including New York Medicaid and Connecticut's HUSKY Health, start with ways to pay for a doula. If you have Medicaid, you usually do not need reimbursement at all: a Medicaid-enrolled doula bills the program, as our New York Medicaid doula guide explains.

Step 1: Call your plan before you pay

Call the member services number on your insurance card, or your HSA or FSA administrator. Have your due date and the doula's name ready. Ask these questions, and write down the date, the name of the person you spoke with and any reference number:

• Are doula services covered under my plan, before birth, during labor or after birth?
• Is there a list of in-network doulas, or will you reimburse an out-of-network doula?
• What does the receipt or claim need to show? Do you need a service code or the doula's NPI number?
• Do you need a letter from my doctor or midwife saying the service is medically necessary?
• What is the deadline to file, and where do I send the claim?
• Can you send me this answer in writing or through my online account?

Step 2: Get the right receipt

A payment app screenshot may not be enough. Many plans want an itemized receipt, sometimes called a superbill. In general terms, it usually lists the doula's name, business name and address, the client's name, each date of service, a plain description of each service and the amount charged and paid. Ask the doula whether they can provide what your plan asked for before you sign, not after the baby arrives.

Some plans also ask for a National Provider Identifier, or NPI. The Centers for Medicare and Medicaid Services describes the NPI as a 10-digit unique identifier for health care providers, issued through its NPPES system. You can look one up in the free NPI Registry. CMS also notes that having an NPI does not mean a provider is licensed or credentialed, and it does not promise payment by a health plan.

Step 3: HSA and FSA paperwork

IRS Publication 502 does not list doula care by name, and it says its list does not include every possible medical expense. Your plan administrator decides whether a doula expense qualifies under your plan. Some administrators ask for a letter of medical necessity from your doctor or midwife. For anything about taxes, ask your plan or a tax professional.

For a health FSA, IRS Publication 969 says you must give the plan a written statement from an independent third party showing the expense was incurred and its amount, plus a statement that no other plan paid it. An FSA cannot reimburse future expenses in advance. FSAs are generally "use it or lose it," though a plan may allow a grace period of up to 2 1/2 months or a limited carryover, so ask about yours.

For an HSA, Publication 969 says you must keep records showing the money went to qualified medical expenses that were not paid from another source. You do not send these records with your tax return, so keep receipts and letters together in one folder.

Step 4: File on time, and know where to turn if you are denied

Each plan sets its own filing deadline, so use the one the plan gave you in Step 1. Send copies, never originals, and keep proof of when you sent the claim. If the plan says no, read the denial letter closely. It should explain why and how to file an internal appeal with the plan.

In New York, the Department of Financial Services takes consumer complaints about insurers through its online portal. Its hotline is (800) 342-3736, Monday to Friday, 8:30 a.m. to 4:30 p.m. DFS also runs external appeals for some denials, such as care called not medically necessary, experimental or out-of-network. You must usually finish the plan's internal appeal first, and patients have 4 months from the final denial to apply.

In Connecticut, the Insurance Department's Consumer Affairs Division is at (800) 203-3447 or insurance@ct.gov. Its External Review program covers some denials, such as medical necessity decisions, and requests must be filed within 120 days of written notice that internal appeals are exhausted. The state Office of the Healthcare Advocate offers free help with denied claims at 1-866-466-4446.

Before you hire, and when reimbursement is not the right plan

Northeast Doulas serves families in Westchester, Fairfield County and New York City, and hiring starts with an intake call, then a match with a doula and an in-person interview. Bring your plan's answers to that call and ask whether the doula can provide the paperwork your plan listed. You can contact the office here. For general background, see our post on whether insurance covers a doula in NY and CT.

Reimbursement is never certain until the plan pays. If you cannot afford to wait or to lose the money, look first at routes with no cost to you, such as New York Medicaid, HUSKY Health or New York City's Citywide Doula Initiative. And if you are still choosing between doulas, our guide on how to choose a doula covers the written agreement and other questions to settle first.