Reimbursement for "Doula" services

[Guest erisa15]

We have a participant who has submitted a claim for reimbursement for the services of a Doula who assisted his wife during delivery. This doula is a woman who assists the mother during labor (providing physical support during delivery) and supplemented nursing care at the hospital. This doula is not a registered nurse.

The doula services are provided to women who do not want to use anesthesia during childbirth. I am leaning towards reimbursement as either nursing care not performed by nurses discussed in IRS Publication 502 or as medical care under 213 as "amounts paid for the " ... mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body."

Has anyone seen this before? Any thoughts would be welcome. Thanks.

[GBurns]

Would you have reimbursed for the services of a Midwife?

What is the difference?

[Guest MSMA]

Doula was a new one to me today, but after a little research it appears that mid-wives can actually deliver babies, while doulas are more of a "support system" - like a birthing "coach".

The question is then, is a doula performing medical care? Most of the sites for/about doulas made claims that indicate that the mere presence of a doula reduces various possible complications. But, of course, they would say that ....

Continuing the thought process...We are allowed to reimburse for lamaze classes for the mother (only) - and I feel that the doula is much more closely related to the lamaze coach than to a mid-wife.

But despite this, I am not convinced that this is reimbursable. I look forward to some more responses here. I must say this was a hot topic in the office today!

[papogi]

I agree with MSMA's analysis. A doula seems most similar to birth classes. I would pay it if the employee can provide something indicating that the doctor at least recommended the services of the doula.

[Guest DK Ellerson]

We had an employee inquire about the services of a doula just last week. Talk about a toughie. We opted to treat the claim as ineligible, because the services don't really fall under the 'medically necessary to treat a specific medical condition' category. I do agree that if, for instance, a single mother-to-be enlisted the services of a doula that would be along the same lines as birthing classes. I also agree with papogi that if a physician recommended the services because of a medical reason, it should be covered.

[Kirk Maldonado]

DK Ellerson:

It seems to me that you are using too strict of a test.

I believe that the appropriate standard is whether the amounts are expended "for the diagnosis, cure, mitigation, treatment or prevention of disease." Additionally, the practitioners need not be licensed by a State authority. The test is the nature of the services rendered, not the experience, qualifications, or title of the person rendering them. See Rev. Rul. 63-91, 1963-1 C.B. 54.

[Guest Suze]

I suppose it won't be long before someone adds to this forum by questioning the meaning of "disease" and how it relates to preganancy!

[GBurns]

If you look at your health insurance you will see that pregnancy, and any complications of that pregnancy, are treated as any other disease. In fact that phrase "treated as any other disease" is fairly common language in health insurance.

Coverage for pregnancy exists without maternity coverage. Maternity is a separate issue usually covering delivery and some post-natal care.