Only a small portion of doulas receive insurance reimbursement at this time, yet the number seems to be increasing gradually. Factors that may increase your chances of reimbursement include:

• Using a certified doula;
  
• Submitting a doctor or midwife's referral or prescription for doula services;
  
• Submitting well documented statistics of doulas' influence upon birth outcomes;
  
• Actually achieving a low intervention, low cost birth;
  
• Submitting a superbill for doula services complete with diagnosis and treatment codes. Some doulas will provide these forms.

As for fees, doula fees in the US run anywhere from $250 to over $1000. Part of it depends upon the doula's training and experience and part of it depends upon the area of the country you live in, and probably, part of it also depends upon your doula's financial philosophy. Whereas some doulas may wish to set their fees as low as possible in order to make their services affordable to as many families as possible, others may take a different approach. My practice is a good example. In setting fees we keep the following in mind:

Doula work takes an enormous commitment on the part of the doula and unfortunately, all too often, takes an enormous toll on the doula's family. I have seen a number of good doulas burn out because they are stretched too thin. At least a part of this seems to be related to the currently low fees many doulas are receiving - fees that do not adequately pay for the support she may need to keep her family running smoothly while she is gone - support perhaps in the form of quick meals, on-call childcare, drivers to move children between school activities and childcare, or even occasional visits to the chiropractor to make up for hours of pressing upon a laboring woman's back or holding her up in a squat.

In the last year, my practice has received insurance reimbursement three times out of a possible 40. This may not seem much, but it is a good start. Our fee is currently $700. It is our goal, however, to set the fee at what we believe a doula is truly worth.

When one considers the cost of surgical birth or the cost of an epidural and all the extended costs associated with surgical or medicated birth, when one considers the odds of avoiding these charges by using a doula, when one considers the tremendous emotional benefit to the client and her family, and especially, when one considers the cost to the doula herself for providing such benefits, it seems easy to justify setting a high value to the doula's services. In our opinion, the doula's services are worth at least, $1000.

This does not mean, of course, that all of our clients will end up paying $1000. Women's Way offers an adjustable fee scale for any client who needs it. But we believe it's important that regardless of the client's ability to pay, both the client and the insurance companies should be clearly informed that the regular fee, the value of the doula, is $1000.

Obviously, this is just one approach to setting doula fees and it is likely that in any given community you will also find practices with much lower fees. Again, the range is very wide and philosophies differ. But it is likely that more and more frequently you may see this value driven approach to setting fees in doula practices, especially as we see more and more doula practices receive insurance reimbursement.