Working with a doula and usings the tricare benefit, Five tips you should know.
When the TRICARE Childbirth and Breastfeeding Support Demonstration (CBSD) was announced as a pilot program in 2021, doulas jumped in headfirst, trying to understand how to navigate this benefit and make it work for military families. During the initial rollout, many were left in the dark navigating an entirely new platform and all the intricacies of insurance. Other states and insurance companies were simultaneously developing and implementing doula coverage so this wasn't unique to just the TRICARE community.
Many of the challenges included understanding and utilizing billing codes, meeting credentialing requirements, reimbursement structures, and other processes for doulas to learn. Over the past several years, reimbursement rates and our understanding of the system have improved. However, there is still a significant amount of confusion and misinformation surrounding the benefit for both doulas and beneficiaries.
Much has changed over the past several years to include the extension of the demonstration to 2031. As a doula and TRICARE provider, it’s important for me to help military families should consider when using their CBSD benefit and ask questions!
Below are some tips gain insight regarding doulas and how Tricare works.
If you have other health insurance , TRICARE may not be your primary payer.
For doulas, coordinating benefits with a primary insurance company can be extremely difficult. In some cases, doulas may need documentation from the primary insurance company before TRICARE will process a claim.
For beneficiaries, if you are looking for a doula last minute, this can become even more complicated. Your doula may not be willing or able to take on the additional administrative work required to pursue payment from multiple insurance companies.
Some doulas are still dealing with unpaid claims long after a client's birth. If you have other health insurance, talk with your doula early about how coordination of benefits may affect your care and the claims process.
Your doula must be Tricare-Credentailed and a participating provider.
There are specific credentialing requirements that doulas must meet in order to provide services under the CBSD to include the updated policy that all doulas must be a participating provider with Tricare. This is particularly important when choosing a doula. If a doula tells you they are not a TRICARE provider but will simply give you a "superbill" to submit for reimbursement, ask questions before moving forward. The process has changed since the early days of the demonstration. Beginning January 1, 2025, participating doulas are required to bill TRICARE directly rather than relying on beneficiaries to submit superbills for covered doula services.
In the early years of the benefit, there were situations where beneficiaries could submit documentation themselves provided by a doula that met the Tricare requirements. That is no longer the standard process. If you had a doula, received a superbill and was reimbursed, there is a likelihood in the next year or two, Tricare might come for recoupment.
Understand what you should and should not be paying out of pocket for.
One of the bigger areas of confusion is the difference between covered doula services and non-covered doula services. As a beneficiary, you generally should not be asked to pay out of pocket for a covered doula service if your doula is working with TRICARE.
However keep in mind there are additional services that are not covered by the demonstration and your doula may offer as a cash pay option. Examples may include things such as:
> Placenta encapsulation
> Childbirth education classes
> Birth photography
>Postpartum Doula Services
> Aromatherapy
>Other products or services outside of the covered doula benefit
If a doula offers these services as part of a larger package, you should be able to understand exactly what is covered and what is not. You should not have to purchase non-covered services in order to access covered doula care. If additional services are being offered, ask your doula to clearly separate the covered services from anything that would be considered private-pay or outside the TRICARE benefit.
Your doula may have a client agreement.
Once you choose a doula, you may be asked to sign a contract or client agreement. Is a contract specifically required by TRICARE? To the best of our knowledge, NO. But that doesn't mean agreements between doulas and clients aren't important. As a doula, we are reserving time for you. When we accept your as a client, we are committing to being available around your estimated due date and potentially being on call for several weeks. There is a lot of time and costs doulas put into their business. We loose income when a client drops services. If you decide to discontinue services at the last minute, your birth plan changes, or you decide you no longer want doula support, that reserved time may be impossible for your doula to fill with another client. For private-pay clients, this is often handled through deposits, cancellation policies, and other financial agreements. With insurance-based services, there may not be an upfront financial investment from the family, the services being rendered are not free which can sometimes create a misunderstanding about the value of the commitment being made on both sides. A client agreement may be in place to help establish expectations for both the family and the doula.
If you do have an agreement, read thoroughly. Make sure you understand cancellation policies, scheduling expectations, covered services, and anything that could result in a private-pay charge.
5. Military Treatment Facility births are not covered by the demonstration.
Another area that continues to create confusion is the use of doulas when giving birth at a Military Treatment Facility (MTF). The CBSD does not currently provide coverage for doula services when the beneficiary is being seen on base for care. You may still be able to have a doula at your MTF birth, depending on that facility's policies, but the doula's services may need to be provided on a private-pay basis rather than billed through the CBSD.
If you are referred off base for your maternity care, your TRICARE plan and referral requirements can also become important. For example, Prime beneficiaries may encounter situations where a referral is warranted, even though general CBSD guidance may indicate that a referral is not required for certain in-network doula services. This is one of those areas where having the appropriate documentation ( a referral from your Primary Care Provider) in place before services begin can prevent significant headaches later. Talk with your PCM, referral office, TRICARE contractor, and doula if you are unsure about what is required for your specific situation.
Disclosure: I do not work for TRICARE, the DoW, DHA, or any other government program. I am a doula who has been working with military families for over 18 years. I have spent years learning how this benefit works from the provider side (and dabbled in policy work behind the scenes). My goal is to advocate for both beneficiaries and doulas. Military families deserve to understand the benefit they have available to them. Doulas deserve to understand how to properly provide and bill for that benefit. Neither side should be left trying to navigate a complicated system without the information they need. There are still unanswered questions, changing processes, and areas where clarification is needed. That is exactly why education and communication are so important. The goal should be simple: families receive the support they are entitled to, and doulas are able to provide that support without being left unpaid or navigating unnecessary administrative battles.