Birth Doula Blog
Tricare Doula Coverage
On January 1, 2022, Tricare debuted their Childbirth and Breastfeeding Support Demonstration which will run until December 31, 2026. This demonstration seeks to study the impact birth doulas and lactation counselors/consultants have on the services of cost, quality of care, and maternal and fetal outcomes for the Tricare population.
In order to get reimbursed for doula services, you must:
•Be at least 20 weeks pregnant upon our first prenatal visit
•Be enrolled in Tricare Prime or Tricare Select
•If you have Tricare Prime, obtain a referral from your PCM to see a provider for the management of your pregnancy AND for doula services
•Choose prenatal care with a Tricare authorized OB/GYN or a Certified Nurse Midwife (CNM)
•Choose in-person labor support. Prenatal and postpartum visits may be in-person or virtual
•Use Tricare as your primary insurance
If you do not meet the above requirements, Tricare will NOT reimburse you and you will be financially responsible for any services provided. It's important to note that virtual labor support or births that take place at an MTF (military hospital) are not covered under this demonstration.
Most doulas, like myself, are participating, non-network certified providers for Tricare, which means you will likely pay out of pocket for services and will be reimbursed by Tricare when services are rendered. You will likely follow the fees and payment schedules outlined in your Birth Doula Services Contract. The doula will be responsible for creating one itemized bill after the postpartum visit or individual ones after every visit that you can submit to Tricare for reimbursement. My specific bill will include dates, location and codes for all of the prenatal visits, birth and our postpartum visit. Itemized bills will total what I advertise on my website for the package you have chosen and I will not bill you more in order to get the maximum allowed fees from Tricare. I do not intend to take advantage of my clients or Tricare.
The allowable reimbursement fees under the demonstration are as follows:
•Up to six antepartum and postpartum visits at a rate of up to $46.00 per visit. Visits are untimed and only one is allowed per day.
•Continuous labor support at a rate of up to $690.00 regardless of length of time and outcome.
Tricare approved doulas have met all of the following requirements to be a Certified Labor Doula under this demonstration.
•Attended a training curriculum of at least 24 hours for doula training
•Attended a breastfeeding course
•Attended a childbirth course
•Provided continuous labor support for at least three births in the last three years, with a minimum of 15 hours over the three births
•Provided antepartum and postpartum support for at least one birth
•Hold a current child, infant, and adult CPR certification
•Have a NPI
The reimbursement and billing process is very new to doulas and Tricare, but I will do my best to work with you and Tricare to ensure you get reimbursed through Humana Military. Every doula has chosen their own conditions when it comes to accepting Tricare beneficiaries. Contact me if you'd like the specific details of my contract.
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