People are often surprised to hear that you can pay for birth doula care using your Health Savings Account (HSA) or your Flexible Spending Account (FSA). In fact, under the IRS regulations, you can pay for 100% of a doula’s fee out of your HSA or FSA account! (See eligible HSA expenses here and eligible FSA expenses here).
To be legally compliant, you must receive a receipt/invoice from your doula and have your doctor sign a “Letter of Medical Necessity.”
In my brief experience in working with insurance companies to help clients receive reimbursement for my services, I realized that the invoice/receipt I had been providing to my clients for my services was not nearly detailed enough to get the job done.
Here’s what I now include in my invoice/receipt for them to retain in their records (or to mail to their health insurer):
In the case of reimbursement, it’s a much more complicated than just sending a detailed invoice. However, for the case of having a receipt in your medical records in case you needed to one day submit it to the IRS for review, I believe this sort of documentation would be sufficient. (Although, definitely double check that with your CPA!)
A “letter of medical necessity” must be completed and signed by a licensed practitioner. (You can download that letter here).
As far as I know, there is no legal restriction as to who can fill out this form – it doesn’t appear that you would even need your Ob-Gyn to fill out the form. The signee just needs to be currently practicing in the medical field, and they need to verify through this form that doula care is a medically necessary expense for your condition (your “condition” would be pregnancy and childbirth).
If you find you need to convince your Ob-Gyn that a doula is medically necessary to your childbirth experience, DONA International, one of the most respected doula organizations in the world (and the one that certifies me!), has lots of convincing information about doula care. (Such as DONA’s “position paper” in which they describe the birth doula’s role in maternity care or the Cochrane Review’s close look at all the studies on doula care – all of which have affirmed a doula’s positive effect on materal and newborn outcomes during childbirth).
The gist? What the studies revealed is that women who had continuous, one-to-one support during labor were:
In short? Continuous support during labor has been shown to have a significant, positive impact on the health of both mom and baby during childbirth and the postpartum period.
NOTE: I am not a CPA, a representative of the IRS or of any health insurer, so this information is purely my own opinion which comes from my own experiences and research. This article in no way guarantees that your health insurer will cover the expense of hiring a doula (or in particular, of hiring me as your doula), and I encourage you to check with your individual health insurer to learn what their policies are in regards to doula care, as it relates to your particular plan.