Insurance companies often don’t cover doulas due to a few key reasons, primarily tied to traditional definitions of medical necessity, standardized billing, and provider credentialing:
- Medical Necessity and Licensing: Many insurance providers consider doulas a non-medical support service, as they don’t provide clinical or medical care. Since doulas focus on emotional, physical, and educational support, their services often fall outside the traditional scope of "medically necessary" services that insurers cover. Doulas aren’t licensed healthcare providers, which also influences insurers' decision to exclude them from standard coverage.
- Lack of Standardized Billing and Credentialing: Doulas are not widely recognized within the standardized billing systems used by insurance companies, such as the CPT (Current Procedural Terminology) codes required for reimbursement. Additionally, there is no single certifying body for doulas, which creates variation in training and practices. This lack of uniformity makes it challenging for insurers to determine reimbursement rates or ensure standardized care.
- Limited Research on Cost Savings: Although studies suggest that doula support can reduce intervention rates, such as C-sections, which can lower healthcare costs, insurers often prioritize services with extensive data on cost-effectiveness. More research and advocacy are needed to illustrate the broader health and cost benefits of doula care, especially in maternity care.
- Coverage for Comparable Services: Many insurers already cover midwifery and nursing services, which include some aspects of support that doulas offer. As a result, they may see doula services as overlapping with what’s already covered under obstetric or midwifery care.
Despite these challenges, some insurers have started pilot programs to assess the benefits of doula services, and a growing number of Medicaid programs in specific states now cover doulas. Continued advocacy and research may help expand insurance coverage for doulas in the future.