24-1270 New: Doula Services Offered to Commercial Plans Starting January 1, 2025
Date: 12/23/24
Doulas give supportive services before, during and after childbirth or a pregnancy event
Research shows that pregnant people who have doula support have a decrease in their cesarean section (C-section) rates and an increase in prenatal and postpartum visit rates. Share the information in this update with pregnant and postpartum Health Net Commercial (HMO, POS, PPO) members to help with their maternal journey.
- Doulas are birth workers who provide health education, advocacy, and physical, emotional, and nonmedical support for pregnant and postpartum persons before, during and after childbirth including support during miscarriage, stillbirth or an abortion.
- Doulas provide education and nonmedical support including health navigation, lactation support, development of a birth plan and linkages to community-based resources.
- Doulas are an integral part of health and wellness for pregnancy, delivery and postpartum care.
- Doulas do not diagnose medical conditions, provide medical advice, or clinical assessment, exam or procedure.
Eligibility requirements
- The member must be active and enrolled with Health Net.
- The member must be pregnant or have been pregnant within the past 12 months and would benefit from doula services.
Covered doula services
Members can receive doula services virtually or in person in any setting, such as home, office, hospital or an alternative birthing center. All visits are limited to one per day, per member.
The initial services include the following:
- One initial visit.
- Additional visits – up to eight given in any combination of prenatal and postpartum visits.
- Labor and delivery support – including a miscarriage, a stillbirth or an abortion.
- Postpartum – up to two extended three-hour visits. These visits do not require the member to meet any criteria or receive a separate recommendation.
Assistive services during visits
Doulas can also give assistive or supportive services during an in-home prenatal or postpartum visit. This support provides face-to-face interaction while helping with emotional or educational support, such as folding laundry or drying dishes with the pregnant member. An assistive or supportive activity with the member cannot be billed to the member.
Coordinating services
Doulas should work with the member’s primary care physician (PCP) or contact Health Net if the member needs additional support.
Non-covered doula services
The following are not covered under doula services:
- Belly binding (traditional/ceremonial)
- Birthing ceremonies (i.e., sealing, closing the bones, etc.)
- Group classes on babywearing
- Massage (maternal or infant)
- Photography
- Placenta encapsulation
- Shopping
- Vaginal steams
- Yoga
Questions about doula services
Providers and other physicians can refer members to contact Member Services about doula services. The number is on the back of their medical identification card.
How to find a Doula?
Call Provider Services at Health Net, 24 hours a day, 7 days a week:
| Line of business | Phone number |
|---|---|
Ambetter PPO | |
Ambetter HMO | |
Health Net Employer Group HMO, POS and PPO |
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Provider Services Center by email, by telephone or through the provider portal. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.