Table of Contents

1. Introduction
2. What Doula Services Are Covered by Insurance
3. Common Non-Covered Doula Services
4. Ethical Considerations When Charging for Non-Covered Services
5. How to Communicate Service Options Transparently
6. Pro-Bono vs. Fee-Based Models
7. Informed Consent and Documentation
8. Avoiding Fraud and Staying Compliant
9. FAQs
10. Conclusion

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Introduction

As the demand for doula care grows, many doulas find themselves navigating a complex landscape of insurance billing, client expectations, and cultural offerings. With programs like Medi-Cal now reimbursing for certain covered doula services, the distinction between covered and non-covered offerings has become more important than ever.

But what happens when a client asks for placenta encapsulation or a birthing ceremony? How can doulas offer these culturally significant or holistic services without crossing ethical lines or legal boundaries?

In this article, we take a deep dive into ethically charging for non-covered doula services, offering guidance on transparency, consent, and compliance.

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What Doula Services Are Covered by Insurance

Medi-Cal recognizes the value of doulas and reimburse for services that include:

• Perinatal education and support
• Birth plan development
• Health system navigation
• Emotional and physical support during labor
• Lactation support
• Postpartum recovery guidance
• Support for miscarriage and abortion
• Referrals to local resources

These services are non-medical, evidence-based, and focused on improving birth outcomes and equity in care.

🔗 More about Medi-Cal covered doula services →

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Common Non-Covered Doula Services

Certain services, while meaningful to clients, are not covered by insurance programs like Medi-Cal:

• Belly binding (traditional or ceremonial)
• Birthing ceremonies (e.g., “closing the bones”)
• Massage therapy
• Photography/videography
• Placenta encapsulation
• Shopping, errands, or in-home support
• Vaginal steaming
• Yoga or movement classes
• Group babywearing or childbirth classes (unless through licensed providers)

Although these are often part of a doula’s holistic offerings, they cannot be billed to insurance.

🛑 Important: Doulas approved by Medi-Cal cannot perform or bill for these services under the Medi-Cal program.

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Ethical Considerations When Charging for Non-Covered Services

Ethical billing starts with clarity and consent.

When offering non-covered services, it’s critical to:

• Clearly separate what is covered by insurance from what is not
• Never imply that non-covered services are required for your covered care
• Avoid bundling non-covered services with reimbursable ones
• Ensure all payments for non-covered services are optional and well-documented

💡 Ethics in doula work means honoring the client's rights and ensuring transparency around pricing, coverage, and consent.

Ethical considerations go beyond legality, they reflect your values and your commitment to reproductive justice, equity, and client autonomy.

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How to Communicate Service Options Transparently

Clients need to understand what they are getting, what’s included with insurance, and what costs extra. Here are best practices:

• Use plain language to describe non-covered services
• Offer a menu of optional services with pricing
• Distinguish covered vs. non-covered in all intake documents and contracts
• Be clear that opting out of non-covered services does not affect their covered care

✔️ Sample language:

“The following services are not covered by Medi-Cal and are available as optional, fee-based add-ons. You may choose to include or decline any of these at your discretion. Your decision will not impact your access to Medi-Cal doula benefits.”

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Pro-Bono vs. Fee-Based Models

1. Pro-Bono Model

Some doulas choose to offer non-covered services for free. This is permissible and ethical, provided that:

• Clients know these services are optional
• Time spent is not billed to Medi-Cal
• You’re not indirectly charging for them by increasing other prices

2. Fee-Based Model

Charging a separate fee for non-covered services is allowed if it is:

• Clearly disclosed
• Itemized in contracts or invoices
• Documented with the client's informed consent
• Not bundled with Medi-Cal covered services

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Informed Consent and Documentation

Informed consent isn’t just a legal formality, it’s a cornerstone of ethical doula care.

📌 Your documentation should include:

• A clear outline of non-covered services
• Individual pricing per service
• A statement that the client has the right to decline
• A signature confirming consent and understanding

Also, make sure clients have time to review, ask questions, and make an informed decision without pressure.

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Avoiding Fraud and Staying Compliant

Improper billing (even unintentionally) can lead to serious consequences.

🚫 Never do the following:

• Charge Medi-Cal for time spent on non-covered services
• Inflate time spent on covered services to “make up” for non-covered ones
• Combine services under a generic billing code that doesn't accurately reflect what was provided

✅ Always:

• Track your time by service type
• Use correct Medi-Cal billing codes
• Keep service logs and signed consent forms

When in doubt, check with your billing administrator or refer to Medi-Cal guidance.

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FAQs

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1. Can I offer placenta encapsulation if I’m a Medi-Cal approved doula?

Yes, but you must not bill Medi-Cal for it and you must clearly charge separately with client consent.

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2. What happens if I accidentally bill for a non-covered service?

This can be considered Medicaid fraud. Contact your program administrator immediately to rectify it.

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3. Can I combine yoga or massage into my covered prenatal support time?

No. These are considered non-covered, separate services, even if you believe they are beneficial.

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4. How can I explain the difference between covered and non-covered services to clients?

Create a simple, visual handout or service menu that clearly divides the two categories.

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5. Do I need a separate contract for non-covered services?

It’s recommended. At minimum, include a separate section in your main contract or addendum.

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6. Can I barter or trade for non-covered services?

Be cautious. Bartering can complicate documentation and raises legal gray areas.

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7. Am I allowed to discount my non-covered services?

Yes, as long as it’s documented, optional, and not a requirement for receiving covered care.

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Conclusion

As a doula, your services often extend beyond what insurance will cover, but that doesn’t mean you can’t offer those services. The key lies in doing so ethically, transparently, and legally. Charging for non-covered doula services can be an empowering way to offer holistic, culturally relevant, and deeply personalized care as long as your clients understand exactly what they’re agreeing to and why.

When you lead with clarity, informed consent, and respect for your clients’ choices, you build trust and maintain integrity in your practice. Whether you're offering birth photography, placenta encapsulation, or ceremonial practices, it's essential to distinguish these services from those covered by programs like Medi-Cal and to document everything thoroughly.

Ultimately, ethical billing isn’t just about avoiding compliance issues, it's about honoring the sacredness of the work you do and the people you serve. Transparency is not only a best practice, it’s a form of care.