How to submit a claim for labour support services with your insurance company

While many insurance companies in the United States have been reimbursing policy holders for labour support services provided by individuals who are not health care providers for several years, this remains uncommon in Canada because private insurers do not incur the costs associated with birth. Even though I am a registered massage therapist (RMT), and thus a regulated health care professional covered under most extended health benefits plans, there is no guarantee that my clients will be able to claim total coverage for my services. I would like to see this change and, as such, I strive to educate my clients on how to advocate for themselves with their insurance companies, and bolster their claims with appropriate documentation.

Change can only happen with consumer demand, so I frequently suggest that people call their insurers before they even submit their claim to ask about labour support coverage from an RMT. Consumers must put forth the argument that having the support of a trained RMT doula is beneficial to their health, to keep asking for this coverage even if they are turned down repeatedly. The squeaky wheel gets the grease, and the more wheels there are squeaking, the more likely insurers will start providing coverage. As such, I am happy to provide my clients with a letter to their insurance company explaining my services and how they fall within my scope of practice as a registered massage therapist, in addition to the specific benefits they provide to the birthing person.

Another thing that is important is educating primary care providers (doctors and midwives) about how their patients will benefit from having RMTs providing labour support services, so as to get them on board with helping patients advocate for these services with insurance providers. It may help your claim if you can get your doctor or midwife to write a letter explaining how having an RMT at your birth was beneficial to your physical and mental health and well-being.

When all services have been rendered, I provide clients with a detailed statement containing my name, registration number, business address, the dates and locations of provision of service, as well as an explanation of the services provided. This does not, however, guarantee the claim will be paid in full, though those with health spending accounts, sometimes called "flex" accounts, are more likely to have better coverage. In requesting reimbursement, explaining to the insurer any health care cost-saving benefits resulting from having the support of a trained RMT doula, and supplying documentation supporting these health benefits, could help you get better coverage. There are many studies supporting the benefit of continuous support during labour.

When calling the insurance company, it may also be helpful to ask to speak to someone at the management level, by phone, and follow up with a written letter, if necessary. Every company, policy and adjuster is different, so it's important to be persistent in requests for coverage, and to keep in mind that, even if your claim is not reimbursed, you may be paving the way for future reimbursements for others, or for yourself with subsequent births. So keep on trying if you truly believe your RMT doula was helpful!