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If you are (or considering becoming) a Tricare Non-Network Doula and could use some guidance, you're in luck! I've created an excellent guide that can help you learn all about working with Tricare as a Non-Network doula. It's detailed, organized, and easy to read. It has helped multiple new and established doulas understand codes, and billing, and find answers to the most common questions. Currently, doulas are left to guess or rely on others' advice to piece together what we should be doing to serve our military families. I recall being in literal tears trying to navigate coding, billing, and searching endlessly on the Humana website for answers. I took all of that knowledge and created this guide just for you! This guide is specific for Tricare East doulas, but lots of the info applies to Tricare West. It's the guide you wish Tricare had provided you with. If you are interested, please make a $25 PayPal payment to @GuidingGatesDoula and you'll get access to the doc. Please include your email in the note. I also offer consults to answer your Tricare questions. Please book here.  Curious about doula coverage with Tricare? Read on to learn more and reach out if you have other questions! Click here to learn more about what a doula is and how she can support you. What's included in the demonstration?
Up to 6 prenatal or postpartum hours and labor support from a Tricare-approved doula. It also covers 6 lactation visits with an approved lactation specialist.
What are the eligibility requirements?
•Be enrolled in Tricare Prime or Select.
•See a Tricare-approved provider for the management of your pregnancy (OB or Certified Nurse Midwife). Certified Professional Midwives are not approved. •Give birth outside of a military treatment facility. Home births are covered with a CNM. •Be at least 20 weeks pregnant for doula support or 27 weeks for lactation support. How do I find a Tricare approved doula?
Log into Health Net if you're in the West region or Humana Military if you're in the East. Be sure to search for In-Network and Non-Network doulas.
What's the difference between In-Network and Non-Network doulas?
If you're on Prime, the main difference for you is that an In-Network doula does not require a referral, whereas an Non-Network doula does. On the doula's part, payment varies between both statuses. Both have met all of Tricare's requirements.
You have the right to choose a Non-Network doula if there's an In-Network doula without availability for your due date. Do I need a referral and how do I get one?
If you have Tricare Prime you will need a referral. Tricare Select does not need one.
Your Tricare-approved provider (OB or CNM) can request a referral. You can provide them with your doula's NPI and name if you already have one or it will be made to any doula and it can be updated to your preferred doula by calling Tricare. If your provider is having a hard time creating one for you, speak to Patient Advocacy or contact your PCM. Will there be any out of pocket costs?
No, doulas should not request any upfront payment from you. However, there are some doulas who offer optional services not covered under the demonstration, such as photography, massage, placenta encapsulation, etc. You will be financially responsible for those if you choose them and they will ask you to sign a Non-Covered Services Waiver.
Are virtual prenatal visits or labor support covered?
No, Tricare does not allow any virtual doula support, but they do cover virtual lactation visits.
Does a doula have to provide me with the six allowable hours?
No, she will likely provide you with the same amount of hours she offers to her non-Tricare clients. That means she might provide you with less or more than six hours. It depends on her business model.
Will the demonstration cover postpartum doulas?
No. However, an approved labor doula may choose when to use any of her six allowable hours. For example, if you did not meet prenatally with your labor doula, she might offer you six postpartum hours. How she uses the six hours is up to her discretion.
Does the demonstration cover labor that ends in a C-section or loss?
Yes, Tricare will cover the cost of doula support no matter the outcome as long as the doula provided any amount of in-person support.
What if I no longer need doula support or she fails to make it?
If during labor you choose not to have a doula, fail to call your doula, or she doesn't make it in time to provide in-person support, you may incur out of pocket costs if she has a no-show policy.
What if a backup doula is used in labor?
Only a Tricare-approved backup doula is eligible under the program and for your doula to receive payment. If she cannot find one, you could use a non-Tricare doula but will likely need to pay for her services.
When should I hire a doula?
You may hire a doula at any point during your pregnancy but Tricare will not cover sessions before 20 weeks. Many doulas book out months in advance, so it's best to secure one within the first trimester.
 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 your 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 |
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