BCBS Doula Coverage: Closing Care Gaps for Families

Blue Cross Blue Shield (BCBS) doula coverage is a game-changer for families seeking comprehensive prenatal and postpartum support.

BCBS offers doula coverage to help bridge the care gap during pregnancy, childbirth, and the postpartum period, which is typically around 6-8 weeks.

Research shows that doula support can reduce cesarean rates by up to 60% and decrease the need for epidural anesthesia by 30%.

This coverage is designed to provide families with the care and support they need to navigate the often overwhelming and unpredictable experience of childbirth.

As a new mom, you'll have access to doula services through your Blue Shield of California Promise Health Plan. You're eligible for these services with a recommendation from your provider.

You can get up to 9 visits with your doula, including an initial visit and up to 8 additional visits that can be a combination of prenatal and postpartum visits. This includes support during labor and delivery, including situations resulting in a stillbirth, abortion, or miscarriage.

These visits can be spread out over time, and you can get up to 2 three-hour postpartum visits, in addition to the 9 visits mentioned above.

Here's a summary of your doula coverage:

You can get doula services up to 12 months after the end of your pregnancy. If you need more visits than what's covered, you can call your provider or our Maternity Care Management team for assistance.

Blue Cross and Blue Shield companies are increasingly supporting doulas, recognizing the positive impact they can have on pregnancy outcomes. Many BCBS companies are including doula coverage in their members' plans.

Some Blue Cross Blue Shield companies, like Blue Cross and Blue Shield of Minnesota, are providing scholarships to increase the number of doulas in underserved areas. This is a great step towards making doula care more accessible to those who need it most.

CareFirst BlueCross BlueShield covers doula services for Medicaid patients, including those who visit organizations like Mamatoto Village. This organization empowers Black mothers with services and education, which is a wonderful initiative.

Blue Cross and Blue Shield of Illinois has provided funding to Chicago Volunteer Doulas, who care for pregnant and new mothers in vulnerable communities. This kind of support is crucial for making a positive impact on these communities.

Here are the details of the doula services covered by Blue Shield of California Promise Health Plan:

Members can get doula services up to 12 months after the end of pregnancy. If you need more doula visits than what is covered, you may be able to get a second recommendation for up to nine more visits.

Blue Cross and Blue Shield companies are increasing support for doulas, recognizing their role in improving birth outcomes. Many BCBS companies include doula coverage in their members' plans.

CareFirst BlueCross BlueShield covers doula services for Medicaid patients, including those who visit the Mamatoto Village, an organization focused on empowering Black mothers. Analyzing claims data, the health plan found that moms who used doulas had healthier outcomes.

Blue Cross and Blue Shield of Minnesota is exploring ways to let members know that doula care is covered and is providing scholarships to increase the number of doulas in areas with the least access.

Many Blue Cross and Blue Shield companies are including doula coverage in their members' plans. This means that more people can access doula services, which can greatly improve birth outcomes.

Blue Cross Blue Shield of Michigan funded a program at Western Michigan University Homer Stryker Medical School to create and train a network of eight community doulas. These doulas assist women at risk of poor birth outcomes.

CareFirst BlueCross BlueShield covers doula services for Medicaid patients. This includes those who visit the innovative Mamatoto Village, which empowers Black mothers with services and education.

Blue Cross and Blue Shield of Illinois has provided funding to Chicago Volunteer Doulas. These doulas care for pregnant and new mothers in vulnerable communities.

Analyzing claims data, Blue Cross and Blue Shield of Minnesota found that moms who used doulas had healthier outcomes. This has inspired the company to explore ways to let members know that doula care is covered.

Doulas have the potential to play a significant role in eliminating racial disparities in maternal health. They may be more trusted members of the community, allowing them to spend time listening to a mother's needs and concerns.

Doulas can provide culturally competent care, which is essential for building trust between a mother and her healthcare provider. This is particularly important for Black women, who face unconscious bias within the traditional healthcare system.

Black women are often dismissed or not taken seriously by their doctors, leading to a lack of trust between patient and doctor. Doulas can help bridge this gap by providing a supportive and non-judgmental space for mothers to express their concerns.

Blue Cross NC has invested in various programs to support doulas across the state, including SEEDS ENC.

Their Healthy Blue Medicaid program offers free support by a certified doula for expecting parents in certain areas who have completed at least 1 prenatal visit.

To raise awareness among members, provider partners, and stakeholder organizations, the Healthy Blue team recently presented at a public health social work conference.

Their presentation reached roughly 75 local health department care managers and other staff, and it led to a problem-solving dialogue at the end of the session.

This demonstrates the power of cross-pollination, driving progress toward a stronger, more responsive doula network in North Carolina.

SEEDS ENC welcomed its first cohort in March, with 8 people completing the DONA International-based curriculum.

The program also features a mentorship component, which nurtures a collaborative peer network across the region's existing doula community.

This is crucial in a state like North Carolina, which earned a D+ on the 2023 March of Dimes Report Card.

The program is specifically designed to address perinatal mental health, a known driver of perinatal mortality.

Most of the 29 counties served by the program are among the state's 40 most economically distressed, where affordability is a significant barrier to care.

Growing families in these areas face real challenges, including difficulty finding care due to provider shortages and transportation issues.

Research shows that doulas can improve care with better outcomes for babies and their parents, especially in under-resourced communities.

These outcomes include fewer cesarean sections, less anxiety and depression, more positive birth experiences, lower costs, and more.

To get a doula recommendation, you'll need a written approval from a provider. This is a requirement for doula services.

You can start by reaching out to your primary care doctor or calling the Blue Shield Promise Maternity Care Management team at (888) 802-4410 (TTY: 711). They're available Monday through Friday from 8 a.m. to 5 p.m. Pacific time.

Blue Shield Promise doula services are part of their effort to improve access to pregnancy care, aiming for a healthy outcome for both parent and baby.

The effective date for reimbursement and billing guidelines for doula services is crucial to know. It's the date when these guidelines take effect and become applicable.

Getting a doula recommendation can seem intimidating, but it's a crucial step in accessing doula services. You'll need a written recommendation from a provider to get started.

First, reach out to your primary care doctor. They can provide a recommendation for a doula. Alternatively, you can call the Blue Shield Promise Maternity Care Management team at (888) 802-4410 (TTY: 711) to get connected with a doula.

To get reimbursed for doula services, you'll need to submit a claim with the appropriate CPT code(s), appended with modifier -HD, as well as modifiers –U7 and/or -22 as applicable. Make sure to include the diagnosis code Z32.2 (encounter for childbirth instruction) in your claim.

Here's a breakdown of the steps to get a doula recommendation:

Reimbursement for doula services is subject to the terms and conditions of your health benefit plan, so be sure to review those carefully.

The medical necessity of the services provided is also a key factor in determining payment. This means that the doula services must be deemed medically necessary for the mother's care.

Your eligibility as a member at the time services are rendered is another important consideration. Make sure you're still covered when you receive doula services.

The provider agreement between the doula and the health insurance company is also a factor in determining payment. This agreement outlines the terms under which the doula will be reimbursed.

Routine claim editing logic, including incidental or mutually exclusive logic, and medical necessity, are also used to determine payment. This means that the insurance company may have specific rules for what is covered and what is not.

Mandated or legislative required criteria will always supersede other factors in determining payment. This means that if there's a law or regulation that requires coverage for a particular service, that will take priority over any other factor.