How to Use Your TRICARE Benefits for Doula Support
If you are a military member or dependent with TRICARE Prime or Select, you may be eligible for new benefits under the Childbirth and Breastfeeding Support Demonstration. This demonstration was announced in October 2021, and began in 2022. This new program expanded lactation counseling support, and added doula support too! All information below pertains to the region I work in, TRICARE West.
Here are some of the new benefits you may be eligible for:
Certified labor doula (CLD) services for pregnant beneficiaries with a gestational age over 20 weeks. The beneficiary must be under the care of a TRICARE-authorized provider (for example, obstetrician, certified nurse midwife, etc.) for the maternity episode of care for
CLD services to be covered under the demonstration.
TRICARE will cover up to six visits by a certified labor doula (CLD) before or after giving birth, as well as one continuous labor support encounter during the birth event.
So how do you know what benefits you’re eligible for?
TRICARE West (aka Health Net Federal Services) has a Prior Authorization, Benefit and Referral tool to determine if approval from your insurance plan is required before services rendered. First, you will use the drop down to select your insurance plan. Then you will mark if your sponsor is active duty or retired.
The next few questions are specific to the doula or provider you are seeing. It will ask you if the provider is in network or out of network. I am an out of network provider. From there you will select if the services provided are inpatient or outpatient. It is my understanding that all doula services are outpatient at this time. You will then scroll down to the next category and click the option listed as “none of the above”, and enter the CPT code 59899. From there you can view your results. I’ve included a screenshot of the tool using TRICARE Prime and my provider type.
As you can see, there are several different options listed. It is important to call your insurance company directly and see what is needed to access your benefits, and what the reimbursement would be for you as this information isn’t something doulas have access to currently.
Interested in doula support? Email me today and let’s see how we can work together!
Kayla
