There are many ways your clients might pay for your doula services and you’ll need to find a path that is right for you and your clients. Whatever benefits we have as consumers, of course we like to use those benefits. As a doula, you’ll be looking at this through an additional lens - what works for you as a provider. At BEST we believe however doulas are paid it should always earn a fair living wage and they should be kept whole, meaning their entire contract fee, as set forth by the doula, is paid.
With private pay, FSA/HSA, and employer benefits you will determine your rate and will be paid prior to providing services per your contract. When accepting Medicaid and private insurance, your reimbursement rate is determined by the policy provider and/or legislation and you will be paid after services are provided; these payments take a prolonged period of time to receive.
Let’s break down how this can look with different payment options.
Private Pay
Your clients may pay you privately with any payment system you choose to use in your business. This may be cash, check, electronic transfers like ACH, Zelle, Venmo, or Paypal, or credit cards. In this scenario, you will determine your contracted rate, how you collect payment, and the payment schedule you prefer, which should be clearly defined on your contract. If you choose to only accept private pay your clients may still have the option to submit their paid invoice to their employer or any other benefits they have that may reimburse them for your doula services.
FSA/HSA
As of December 2023, your clients can use a Health Savings Account (HSA) or a Flexible Spending Account (FSA) to pay for doula services. Most of the time clients do not need a note or prescription from their health care provider, but they may request it. Your client may like to contact their FSA/HSA to confirm that doula services is an approved expense. For clients, this is income they have set aside that is not taxable, so it could be a savings of 30% for them. For the doula, if you accept credit cards and are approved for HSA/FSA you generally won’t see any difference between your client paying with this account or a debit or credit card. You determine your rate and payment schedule.
CARROT and Other Employee Benefits
CARROT Fertility is company that many employers are contracting with to provide employee benefits beyond their company’s insurance options. CARROT provides reimbursement for many fertility expenses as well as birth doula and postpartum doulas. Your client will want to confirm their CARROT coverage, you’ll have a conversation with them about their needs and sign a contract. The client will pay the doula directly with the doula determining the rate and payment schedule. CARROT will send the doula an attestation and will reimburse their customer for the expense. This is an incredible benefit that is covering as much birth doula coverage and postpartum doula coverage for as much as 16 hours a day for six weeks postpartum - a really incredible option for those who have this benefit. And yes, BEST Doulas qualify for CARROT reimbursement for their clients.
Many other companies like Walmart, Microsoft, CVS Health, and PNC Bank offer employee benefits that cover doula services as well. The doula will determine the rate and payment schedule.
Medicaid
Medicaid benefits vary by state, but many states are adding doula support to their list of medicaid benefits. Each state has a slightly different approach to defining which doulas may participate and payment rates. Unfortunately, these typically look very different from a standard doula contract. BEST is working with every state, on a state by state basis, so that BEST Certified Doulas can support Medicaid clients if they wish. You can view a list of states who are including doula care in their Medicaid benefits and their payment schedule here. If you choose to accept Medicaid you will sign with the Medicaid provider and bill Medicaid for services after services are rendered, and abide by all regulations and laws pertaining to Medicaid. The exact process for Medicaid reimbursement varies by state. At this time BEST is approved in California, Michigan, Maryland, New York, Rhode Island, Pennsylvania, Virginia, Florida, Nevada and Massachusetts and has completed all requirements for Oklahoma and is in process with Colorado, New Jersey, Minnesota, Illinois, and Washington DC.
Private health insurance
As of February 2023, Rhode Island is the only state that requires private health insurance plans to cover doula care by all fully insured commercial plans offered by a Rhode Island licensed insurer and issued after July 1, 2022. Louisiana and Illinois have also passed legislation (Louisiana HB 272 and Illinois HB 5142) requring private health plans to cover doula services.