TriCare Doula Coverage at EDBD

As doula support becomes more popular, some insurances have begun to cover doula services. I am thrilled that this means doula care is more accessible to some families, and also it is quite a process as a doula to navigate accepting insurance. So this blog post is an explanation of how I make TriCare coverage work for me and my clients. I hope this information is helpful to you if you are covered by TriCare and exploring doula support, and also helpful if you are doula interested in learning more.

Let’s talk about TriCare. TriCare is a military insurance, and often covers people who are active and in reserve. Since I serve families in the region of the Navy Shipyard in Portsmouth, I encounter families with TriCare often.

For other doulas…

If you want to be covered by TriCare, you need to go through an authorization process. It’s not hard, it’s just a bit cumbersome. You will then be authorized to be covered as an “out of network” service, not “in network.” This is what I did, the webpage for this process is here. 

As the client, there are a couple qualifications you have to hit to have doula support covered. 

• You must be 20 weeks pregnant 

• Have a referral if you need one 

• Be receiving care (and planning to birth at) a facility that accepts TriCare

The type of TriCare plan matters for doula coverage. Prime coverage requires a referral for doula support and Select coverage does not. So check with your plan, and if you require a referral contact your PCP or OB to get one. A note- often PCP’s or OB’s are not aware TriCare will cover doula services, and don’t know how to make the referral. So clients have been connecting with me first, and I give them my name, address, and NPI to give to their provider so they can make the referral. 

TriCare will cover six visits (prenatal and postpartum) and the “birth event.” There are some parameters for this coverage, and they are all detailed in the materials you receive when you get authorized. The rate they cover these services (as of 1/2024) is $46 per prenatal/postpartum visit, and $690 for the birth event. I choose to wait until all services have been completed before I submit a claim that lists all the events on it. 

More on the money, and then I will talk about my experience so far…

My fee is $2000 for my birth support package, so TriCare covers just about half of my full fee. I also have a sliding scale fee system, and I am willing (and have) combined TriCare and the sliding scale, so the lowest amount a client could pay out of pocket is around $500. 

I have two options of how the payments and reimbursement works. The first is my client pays me my complete fee and when I get reimbursed by TriCare, I reimburse my client. This is my preference since I get the money from TriCare months after the birth. For clients where this is not financially feasible, I have them pay $500 as a retainer, and then charge them for any difference after TriCare has paid out. These are the set-ups I have figured out for me and my clients, but there are a lot of possibilities. (A note for doulas- if you are authorized and become an “in network” provider you then aren’t allowed to charge anything on top of what TriCare pays, so that is why I am not “in network”).

My experience so far…

I have supported 5 TriCare clients so far, and my experiences getting reimbursed from TriCare have varied between them. What they have all had in common is that the claim I originally submitted is denied and I have to resubmit it. Somehow early on I got a hold of someone at TriCare and have been able to email them directly for support where they can answer my questions and escalate my claims to get them approved. Even with her support, I have submitted two to four claims per client before they are approved. And I have only completed the process of being fully reimbursed one time. It is a process of patience and persistence for sure. I definitely understand why people choose to not take insurance. 

Doulas- if you choose to go down this path, I will give you my contact’s email address because she is the only reason I have made this work. 

In summary…

If you have TriCare insurance and want doula support, please reach out, and we will make it work. It won’t cover the fee completely, but we will make a plan that works for you. Please message me if you have any questions, I am happy to chat more. 

If you are a doula who is interested in becoming authorized to take TriCare, also please reach out, I have a lot more thoughts and will happily support you in this process.