Plan Perks

The following are doula services covered by the plan for each stage of pregnancy:

Antepartum Visits

Antepartum services may include the following:

• Review the member’s home environment, equipment, child-care needs, transportation needs and requirement for interpreter services
• Review the member’s support system (family, friends and/or significant other)
• Discuss the member’s preferred infant feeding method
• If breastfeeding is preferred, assist in scheduling lactation consult post-delivery
• Provide information regarding prenatal classes
• Identify place of delivery and mode of transportation, if applicable
• Discuss the member’s expectation of the birth experience, labor and delivery process and anesthesia, including discussion of a birth plan to be shared with delivering provider (OB-GYN or midwife)
• Support and reinforce information provided in prenatal classes concerning labor, delivery and postpartum care of both the member and the newborn, including to: 
• Confirm that there is a car seat available for transporting the infant
• Review infant safe sleeping practices
• Offer suggestions for coping strategies in the postpartum period
• Discuss notification of active labor and expectations regarding attendance during the labor and delivery process

Labor and Delivery Attendance 

Services provided during labor and delivery may include the following:

• At the member’s request, be present at the birth and remain through the immediate postpartum period
• Provide help and guidance on measures for comfort and pain relief, such as breathing, relaxation, movement, positioning and comforting touch
• Provide emotional support and facilitate communication with hospital staff
• Provide immediate postpartum support and initiation of breastfeeding, as needed (if applicable and trained to provide such breastfeeding support)

Postpartum Visits 

Postpartum services may include the following:

• Discuss the birth experience
• Discuss importance of postpartum physician/midwife follow-up care
• Follow up on the infant’s first wellness checkup scheduling
• Encourage member to discuss the immunization schedule with the child’s health-care provider
• If breastfeeding, provide support
• Review recommendations for postpartum health, including rest/sleep
• Assist in prioritizing offers of help from friends and extended family
• Assist the member in understanding baby cues and suggest techniques for soothing the baby
• Demonstrate and have the member provide a return demonstration of infant care
• Educate the member on infant carrying devices available

The following services are not covered:

• Ongoing, regular child care
• Housekeeping assistance
• Medical diagnosis or treatment
• Administration of medications

The doula claim form (PDF, 790 KB) can be used only when services are rendered by doulas before, during and after a birth. It cannot be used for other services not associated with doulas or pregnancy. Please refer to the covered services referenced and benefit maximum above.

This form was created to help you submit claims for services rendered by doulas who may be unfamiliar with insurance claim processes. These providers may require you to pay for services up front prior to filing a claim with UHC. Services must be completed before a claim can be submitted; deposits or pre-payments cannot be reimbursed until after services have occurred. Once a claim is received, appropriate amounts will be credited toward your in-network deductible and out-of-pocket maximum. You may receive reimbursement if your deductible has already been met.

To ensure faster processing of your claim, be sure to do the following: 

Use black or blue ink and print clearly and legibly. Complete all the applicable fields on the form. Ask your provider for their license/certification number or have them fill that out for you below. Be sure to submit a separate form for each claim and to attach an itemized receipt/invoice after services have occurred. The itemized receipt/invoice must contain a summary of services, corresponding dates of service, total cost, and proof of payment, if applicable.

Once you have completed the doula claim form, mail or fax it to the address/number listed below and be sure to include the cover sheet at the top of your paperwork. Be sure to attach copies of your itemized invoice or itemized receipt detailing what services occurred.

The address and fax number are as follows:

UnitedHealthcare Claims

P.O. Box 30431

Salt Lake City UT, 84130

Fax #: 801-938-2102

After UnitedHealthcare processes your claim, they will send you an Explanation of Benefits (EOB) in the mail or online, depending on your elected preference. The EOB will explain the charges, how these amounts applied to your plan deductible and out-of-pocket maximum, as well as any reimbursement that may be due to you. You may also view your EOB information online at myuhc.com.

Yes, you can use your General Purpose FSA (or Limited Purpose FSA if you have reached the medical deductible) for reimbursements of out-of-pocket doula expenses in excess of the $3,000 maximum benefit.

Please include the Letter of Medical Necessity (LMN) when submitting the reimbursement request to Optum to be reimbursed from your FSA.

• Download a doula claim form (PDF, 790 KB)
• Download the Letter of Medical Necessity (PDF, 160 KB)