The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Doula Letter To Clients About Reimbursement

I too thought her forms were complicated, so I'll describe mine here. At the top, I put,

To our clients,

This receipt is for your medical records to indicate that you have paid for our doula services. A few insurance companies reimburse expectant parents for all or part of doula services or if you have a health care reimbursement account, this may qualify for reimbursement as a medical expense. We suggest that you complete this form and mail a copy of it with your own insurance carrier's claim form to request this reimbursement. To increase your chances of reimbursement, you should also include: a prescription from your physician/midwife for our services (if possible) and a letter stating the research findings associated with doula care and why you chose to hire a doula.

Please detach here before mailing

Our business name
My name, credentials, address/phone
My partners

Then I made a box with room for client's name, address, ss#, phones, subscriber and ID #, group #, a place to list other coverage. I made a box for the ICD-9 Diagnosis Code of V22.1 of Iup. Intra-uterine Preg. Also places for EDC, referring physician, a release. Then another box with the codes for private class or doula service, my fee, amount paid and balance due. Last box with my signature and date.

If I knew how to attach something from my word processing files into aol e-mail I would be happy to do this as the form looks pretty good (if I may say so myself!)

Anyone is welcome to use my top paragraph and this format, after all, I patterned it after others. Also, if anyone has any ideas/suggestions for improvement, let me know. Also, in our prenatal packet, we give them info on advantages of doulas and the K&K study from Mothering the Mother that they can cite to insurance.