Did you know that you can use your Health Spending Account (HSA) or 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, our clients have had very few problems using their HSA or FSA. We still recommend this route as the easiest pathway for our clients with this option.

Insurance is a state's rights issue. Medi-Cal does have doula support as a covered benefit in California. Enrollment of doulas as providers is slowly rolling out, but in many cases the reimbursement rate through managed care plans is for birth coverage, and the payments so low that not many doulas have opted in. The prenatal and postpartum visits are also a different model than what most doulas are used to. In other states, Medicaid programs are rolling out doula coverage slowly. Third party HMO insurances, like Kaiser for their commercial clients, indicate that a doula is a covered benefit with a direct billing option, but have made their reimbursements lower or with an adjusted model of care. Expect to see PPOs offering doula coverage in 2026. This is all to say that 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 HSA, FSA, or insurance 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. Codes may be different state by state or insurance by insurance.

Check with your HR Department. Many Bay Area companies include birth and/or postpartum doula services as part of Maternity/Family Leave benefits. Carrot, Maven, and Progeny are all benefit companies that we have successfully worked with to get your reimbursement covered.

Here is a checklist and some tips for getting reimbursed:

1. Pay your doula in full.
2. Get an invoice from your doula which includes the following information:
   • The doula's name and address
   • Doula's NPI number and/or taxpayer ID number (EIN or TIN)
   • The date and location services were provided
   • Diagnosis code and taxonomy code
   • The doula's signature
3. Submit the invoice with a claim form to your insurance company.
4. Within 4 weeks, expect a letter telling you either that:
   • They need more information before they can process your claim
   • This is not a covered expense

Some other paperwork that might be helpful in your claim:

• a copy of your doula's certification (if certified)
• other credentials of your doula or relevant training
• a letter from your doula detailing their training and experience and the support they provided you
• a letter from your physician or midwife 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?) In some cases, having your care provider write a prescription for doula services can help get them covered.
• a letter from you explaining why you felt the need for a doula and how you believe the doula was beneficial to your health
• if you are a Medi-Cal beneficiary, make sure to get your physician or midwive to approve your additional 9 doula check-ins postpartum. This is a covered benefit to which you have a right.

If your claim in refused:

• 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
• 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.

DONA International has been fighting for Third Party Reimbursement for doulas since 1992. Support their mission by helping advocate for doula coverage under insurance and a living wage for all doulas doing this important work. Parts of this checklist were excerpted from instructions originally given by Kelli Way, ICCE, CD(DONA) 1998 with permission granted to reproduce with complete attribution.