Finding TRICARE Doula Support at Offutt AFB
Today I got my first claim back from TRICARE, and I was so excited to see my clients utilize their new insurance covered services through the Childbirth and Breastfeeding Support Demonstration. So I thought I would share the process of qualifying for and hiring a TRICARE approved doula. I'm the first and only TRICARE approved certified labor doula in the state of Nebraska. I'm also a military spouse, so I've been on both sides of the system. All information below is up to date as of July 2022, for any specific insurance questions, or to verify any updates to the policies, you can always call TRICARE.
How do I qualify for doula services?
To qualify, you must:
Be enrolled in TRICARE Prime or TRICARE Select
Be at least 20 weeks pregnant
See a TRICARE-authorized provider for your birth event.
You can’t plan to give birth in a military hospital or clinic as part of the CBSD.
Use a TRICARE approved Certified Doula.
If you’re enrolled in TRICARE Prime, you’ll need a referral from your primary care physician or manager if you see a non-network provider. Point-of-service charges may apply without the referral.
Do I need a referral?
The short answer is probably yes. To verify, go to TRICARE’s website and use the Prior Authorization, Referral, and Benefit tool. You’ll fill out your information and put in the CPT code 59899 and the website will give you the current recommendation. Your doula cannot request a referral for you, but you can request one from your OB/provider. If you are:
Active Duty: You WILL need a referral regardless of provider's network status.
Prime Beneficiary: If your doula is a non-network provider, you will need a referral. It may not be required for in-network providers.
Select Beneficiary: It is unclear if you will need a referral for a non-network provider or in-network provider.
How do I find a doula authorized to participate?
You can go to the CBSD Directory and search for providers near you. Keep in mind some providers (like me) are non-network providers so you may have to toggle that option to find a doula near you. At this time, I am the only certified labor doula you can use your TRICARE benefits with, but my hope is that other doulas will apply to the demonstration.
If you are interested in becoming a doula or becoming TRICARE authorized, check out my next blog post with the information to do so!
What is TRICARE covering?
TRICARE is authorized to reimburse/partially reimburse six total antepartum and postpartum CLD visits (after 20 weeks of pregnancy) and one continuous labor support encounter per birth event. However, all small business owners (doulas) offer different service packages depending on their availability and skill set.
If you are interested in learning more about my doula services and availability, email me today at hello@thebirthchronicles.co
