A receipt + a signed letter, and you’re covered.

People are often surprised to hear that you can pay for Birth Doula care using your Health Savings Account (HSA) or your Flexible Spending Account (FSA). In fact, under the IRS regulations, you can pay for 100% of a doula’s fee out of your HSA or FSA account! (See eligible HSA expenses here and eligible FSA expenses here).

To be legally compliant, you must receive a receipt/invoice from your doula and have your doctor sign a “Letter of Medical Necessity.”

1. Receipt/Invoice from your birth doula:

In my brief experience in working with insurance companies to help clients receive reimbursement for my services, I realized that the invoice/receipt I had been providing to my clients for my services was not nearly detailed enough to get the job done.

Here’s what I now include in my invoice/receipt for them to retain in their records (or to mail to their health insurer):

• My business name, mailing address, email address, and phone number (if I had a fax number, I’d probably include that, too ;-));
• My full legal name (my business is a sole-proprietorship LLC) and social security number (in place of the doula’s SS, the doula could also use your Tax Identification Number or Employer Identification Number, if your doula has one);
• My doula license number, since I’m certified through DONA International;
• My NPI (National Provider Identification) number, a registry used by all healthcare professionals (if your doula doesn’t have one, it’s very easy to apply for one here);
• The Doula taxonomy code (374J00000X);
• Appropriate CPT (Current Procedural Terminology) and ICD10 codes (not all doulas feel comfortable assigning CPT or ICD10 codes, so that’s up to your doula how she wants to handle this);
• Dates and Locations of the services I provided to my client;
• A detailed description of the services provided to my client;
• The total due for services, the amount paid, and the date when they paid in full;
• My signature.

In the case of reimbursement, it’s a much more complicated than just sending a detailed invoice. However, for the case of having a receipt in your medical records in case you needed to one day submit it to the IRS for review, I believe this sort of documentation would be sufficient. (Although, definitely double check that with your CPA!)

       2. “Letter of Medical Necessity”:

A “letter of medical necessity” must be completed and signed by a licensed practitioner. (You can download that letter here). 

As far as I know, there is no legal restriction as to who can fill out this form – it doesn’t appear that you would even need your Ob-Gyn to fill out the form. The signee just needs to be currently practicing in the medical field, and they need to verify through this form that doula care is a medically necessary expense for your condition (your “condition” would be pregnancy and childbirth).

Why Doula Care is Medically Necessary

If you find you need to convince your Ob-Gyn that a doula is medically necessary to your childbirth experience, DONA International, one of the most respected doula organizations in the world (and the one that certifies me!), has lots of convincing information about doula care. (Such as DONA’s “position paper” in which they describe the birth doula’s role in maternity care or the Cochrane Review’s close look at all the studies on doula care – all of which have affirmed a doula’s positive effect on materal and newborn outcomes during childbirth).

The gist? What the studies revealed is that women who had continuous, one-to-one support during labor were:

• more likely to have shorter labors;
• less likely to use pain medication;
• more likely to have a spontaneous vaginal birth (where a mom pushes out her baby on her own);
• less likely to have an “instrumental” vaginal birth (where a doctor assists the mother in birthing the baby by using forceps or vacuum extraction);
• less likely to birth by cesarean surgery;
• less likely to give birth to a baby who has a low five-minute Apgar score (the scale they use to analyze a baby’s breathing, oxygen intake, and general health just after the delivery);
• less likely to have reported negative feelings about their birth experience;
• slightly less likely to experience postpartum depression;
• slightly more likely to experience “difficulty in mothering” (a sort of vague term, which seems to relate to a mother’s experience of being a mother overall).

In short? Continuous support during labor has been shown to have a significant, positive impact on the health of both mom and baby during childbirth and the postpartum period.

NOTE: I am not a CPA, a representative of the IRS or of any health insurer, so this information is purely my own opinion which comes from my own experiences and research. This article in no way guarantees that your health insurer will cover the expense of hiring a doula (or in particular, of hiring me as your doula), and I encourage you to check with your individual health insurer to learn what their policies are in regards to doula care, as it relates to your particular plan.