Introduction: The Future of Doula Care in California

California has made significant strides in expanding access to doula services through insurance coverage, particularly with Medi-Cal benefits. For doulas, this opens up an exciting opportunity to serve more families while building a financially sustainable practice that doesn't compromise on quality care.

Here's the beautiful part: accepting insurance doesn't mean abandoning everything that makes you a great doula. It simply means getting creative with how you structure your services to work within a different framework. Many successful doulas have discovered that this shift actually enhances their practice by bringing more intention and structure to their client relationships.

The traditional doula model of comprehensive packages paid upfront does look different from insurance-based visit structures, but this difference creates space for innovation. With some flexibility, creativity, and strategic thinking, you can maintain the personalized, client-centered care that drew you to doula work while making your services accessible to families who truly need them.

At its heart, this transition is about expanding access to quality doula care while ensuring you can sustain your practice long-term. Let's explore how to make this work for both you and the families you serve.

‍

Understanding Insurance Reimbursement for Doulas

Insurance reimbursement for doula services in California operates on a visit-based system rather than the traditional package model many doulas know well. While this might feel like a big shift initially, many doulas find that this structure actually brings more clarity and intention to their client interactions.

The key insight here is that financial sustainability comes from thoughtfully adapting your practice model to work within the insurance framework while maintaining the quality, personalized care your clients deserve. Consider offering completely separate packages for insurance and private-pay clients, or you might choose to align all your packages to match your insurance offerings for consistency – whatever feels most authentic to your practice style. You might find this approach easier than trying to squish your existing private practice model to fit the insurance benefit visit structure.

When you accept insurance, you're trading the upfront payment model for reimbursement per completed visit. Some doulas find that this can actually provide more predictable cash flow, especially when collaborating with a provider network like Loula that offers consistent, guaranteed payment for rendered services.

Perhaps most importantly, the insurance model opens doors to serve diverse populations who previously couldn't afford doula services. This aligns beautifully with the core mission of doula work: ensuring all families have access to supportive, compassionate care during one of life's most transformative experiences.

‍

Visit Structure and Reimbursement Rates as of 2025

Understanding the specific visit types and their reimbursement rates helps you design care models that work for both your practice and your clients' needs. California's insurance system recognizes several categories of doula services, giving you flexibility in how you structure support:

Perinatal Visits

Initial Perinatal Visit: This foundational 90-minute appointment reimburses at $197.98 and gives you substantial time for comprehensive assessment, care planning, and relationship building. Think of this as your opportunity to really get to know your client and their unique needs.

Standard Perinatal Visits: These flexible visits reimburse at $162.11 each and offer significant duration flexibility. You can conduct up to 8 of these visits, and DHCS Medi-Cal doula guidelines do not specify a particular time limit, allowing you to tailor visit length to each client's specific needs while maintaining the same reimbursement rate.

Extended Postpartum Visits: These substantial visits can last up to 3 hours and are billed in 15-minute increments, with a full 3-hour visit reimbursing at $486.36. Your client is authorized for 2 of these visits per pregnancy, which can be incredibly valuable during the intensive early postpartum period.

Additional Postpartum Visits: Exclusively for Medi-Cal clients with a licensed provider's recommendation, these 9 additional visits at $162.11 each can provide extended support for families who need extra care during their postpartum journey.

Labor and Delivery Support

Birth support reimbursement varies by delivery type:

• Vaginal delivery: $685.07
• VBAC (Vaginal Birth After Cesarean): $768.69
• C-Section: $795.73
• Miscarriage support: $250.85
• Abortion support: $250.85

‍

Creative Care Models for Insurance-Based Doula Services

The beauty of working within the insurance framework is discovering how many different ways you can structure meaningful, comprehensive care. Here are some real-life approaches that have worked well for doulas within the Loula doula provider network – feel free to adapt them to match your style and your clients' needs:

Birth Doula Packages

Mixed In-Person and Virtual Model

This approach balances the intimacy of face-to-face connection with the convenience and accessibility of virtual support. Consider structuring it like this:

• One 90-minute initial prenatal visit in-person ($197.98) for deep connection and planning
• Two standard prenatal visits in-person ($162.11 each) for hands-on preparation
• Six standard prenatal visits conducted virtually ($162.11 each) for ongoing quick check-ins and guidance
• Labor and delivery support in-person ($685.07-$795.73) for your full presence during birth
• Two extended postpartum visits in-person ($486.36 each) for comprehensive early support

Total potential earnings: $3,152.65

This model involves 5 in-person visits and 6 virtual appointments, making it manageable for doulas serving clients across larger areas while maintaining that essential personal connection.

Virtual-First Model

For doulas who want to serve clients over wider geographic areas or prefer the efficiency of virtual connection, this model emphasizes digital support without sacrificing quality:

• Initial 90-minute prenatal visit conducted virtually ($197.98) for comprehensive planning
• One standard prenatal visit in-person ($162.11) for initial connection
• Seven standard prenatal visits conducted virtually ($162.11 each) for ongoing support
• Labor and delivery support in-person ($685.07-$795.73) for birth presence
• One extended postpartum visit in-person ($486.36) for crucial early support
• One extended postpartum visit conducted virtually ($486.36) for extended check-ins

Total potential earnings: $3,152.65

This model reduces in-person visits to just 2 while maintaining earning potential, perfect for doulas who want to maximize their time efficiency while serving more families.

Postpartum Doula Services

Families seeking postpartum-focused support might thrive with this specialized approach:

• One initial 90-minute prenatal visit conducted virtually ($197.98) for comprehensive planning
• One standard prenatal visit in-person ($162.11) for birth preparation
• Seven standard postpartum visits in-person, typically 60-120 minutes each ($162.11 each) for hands-on support
• Two extended postpartum visits in-person ($486.36 each) for intensive care periods

Total potential earnings: $2,467.58

This model emphasizes the postpartum period when families often need the most practical, emotional support, with 10 in-person visits providing substantial hands-on assistance when it matters most.

Full-Spectrum Doula Care

This comprehensive model supports families throughout their entire journey:

• One 90-minute initial prenatal visit in-person ($197.98) for relationship building
• Two standard prenatal visits in-person ($162.11 each) for preparation
• Three standard prenatal visits conducted virtually ($162.11 each) for ongoing guidance
• Labor and delivery support in-person ($685.07-$795.73) for birth presence
• Two extended postpartum visits in-person ($486.36 each) for early support
• Three standard postpartum visits conducted virtually ($162.11 each) for continued care

Total potential earnings: $3,152.65

This balanced approach provides continuous support from pregnancy through postpartum while maintaining financial sustainability.

‍

Building Strong Relationships & Accountability with Insurance Clients

Working with insurance clients offers a wonderful opportunity to build structured, professional relationships that serve everyone well. Since families aren't paying large sums upfront, creating clear expectations and boundaries helps establish trust and mutual respect.

Contract Essentials

Every client relationship should begin with a comprehensive contract – this should be a non-negotiable because it protects everyone involved. Your time and expertise have value, and contracts ensure all parties understand expectations, visit schedules, and boundaries. Include clear descriptions of covered and non-covered services, visit policies, and how you communicate with clients.

Thoughtful Scheduling

Consider scheduling all visits during your initial appointment rather than booking as you go. Many doulas find this proactive approach reduces scheduling conflicts and no-shows while demonstrating professionalism and intentionality. We recommend setting up automated reminders and confirmation emails or texts to ensure your client doesn’t forget their upcoming appointment or can give you advanced notice if they won’t make it.

Managing No-Shows

For non-Medi-Cal insurance clients, consider including no-show fees equal to the visit amount in your contracts, since insurance won't reimburse for missed appointments. However, no-show fees are not permitted for Medi-Cal clients, so focus on other relationship-building strategies like clear scheduling expectations, reminder systems, and contract termination policies. For Medi-Cal clients, you might include policies about what happens after repeated missed visits (such as after 3 no-shows) to ensure commitment to the care process.

sIn general, we find that when doulas are transparent with their clients about not getting paid for missed or canceled appointments, clients develop more empathy for your situation, which in turn increases accountability.

‍

Making Insurance Work: Tips for Financial Sustainability

The goal here isn't to squeeze every dollar out of the system – it's to ensure your practice remains financially viable so you can continue providing excellent care to families who need you. Here are some strategies that support both sustainability and client-centered care:

Thoughtful Use of Extended Visits

Extended postpartum visits offer substantial time for comprehensive support. Consider how to use these 3-hour visits most effectively for your clients – perhaps combining practical support, feeding assistance, emotional processing, and family education. The full 3-hour duration can provide incredible value to families during the intense early postpartum period. Be mindful that completing less than 3 hours for this particular visit type will yield less payment.

Leveraging Additional Postpartum Visits

For Medi-Cal clients, those 9 additional postpartum visits with a licensed provider recommendation can provide extended support for families who would truly benefit from longer-term care. Think about families with complex needs, first-time parents, or those facing challenges – these visits can make a real difference in their postpartum experience.

Strategic Virtual Connections

Virtual visits enable you to maintain consistent connection with clients while managing your time efficiently. Phone and video calls count as billable visits, which means those check-in calls that clients often need can be both supportive and sustainable for your practice. When clients text with questions, you might suggest a brief phone conversation (we recommend at least 15 minutes) instead – it's more personal and allows for billing.

Protecting Your Energy

Consider setting boundaries around visit length that work for both you and your clients. While you can extend beyond minimum times, ensure your schedule allows for the kind of presence and attention each family deserves while also allowing you to care for yourself and your personal priorities.

Multi-Day Labor Considerations

When you're supporting clients through extended early labor before active labor begins, those preliminary support days can be billed as standard prenatal visits. This ensures you're appropriately compensated for the time you spend providing comfort and guidance during early labor phases.

Bundling Delivery Day Visits

For most visit types you are only permitted to bill for one visit per day per client. However, on delivery day, you can bill for labor and delivery support as well as one other visit. This could be either a prenatal or postpartum visit, so if you support the client for hours in the morning on the day of delivery prior to active labor, you could bill that as a prenatal visit. Alternatively, if you stay for hours with your client supporting them after delivery, you could bill that as a postpartum or extended postpartum visit.

‍

Staying Compliant: Essential Requirements

Compliance with insurance regulations protects both you and your clients while ensuring you can continue serving families through insurance coverage. These requirements are mandatory – there's no flexibility here, but they're straightforward to follow with good systems in place.

Billing Compliance

Never charge clients for services covered by their insurance. Any additional fees must be for non-covered services only, with written notice provided to clients and clear documentation in contracts. This is a hard line that protects both you and your clients.

Documentation Requirements

Maintain detailed, accurate chart notes for every visit. Notes must precisely reflect the time spent with clients and should justify the duration of the visit. Visit dates and duration must be accurate, as these records may be audited by health plans. Focus your documentation on the services you provided and your objective observations.

Client Communication

Keep clients informed about all billed visits. They will receive Explanation of Benefits (EOBs) from their insurance company for all visits that you bill for. Clear communication prevents confusion and maintains trust. Explain your billing practices during initial visits and provide updates as needed.

Record Keeping

Maintain organized records of all visits, communications, and billing activities. Proper documentation protects you during audits and ensures accurate billing practices. Consider using practice management software designed for healthcare providers to streamline these requirements and make compliance easier.

‍

Frequently Asked Questions

Can I charge additional fees to insurance clients?Yes, but only for services not covered by insurance. You must provide written notice of additional fees and clearly list non-covered services in your contracts. Never charge for services that insurance covers.

What are the coverage differences between Medi-Cal/Medi-Cal managed care and other insurance plans?Medi-Cal clients can access 9 additional postpartum visits with a licensed provider recommendation, and you cannot charge no-show fees.

How long can virtual visits last?In California, virtual visits have the same time requirement as in-person visits. Standard visits don't have specified time limits according to DHCS guidelines; however, the initial visit must be at least 90 minutes and extended postpartum visits are billed in 15 minute increments with a 3 hour cap.

Can I bill for phone calls with clients?Yes! Structured phone or video calls can be billed as visits, but general texting and on-call availability cannot. Consider encouraging clients to schedule brief phone consultations for questions and support rather than relying solely on text communication.

What happens if a client misses appointments?Insurance won't reimburse for missed appointments. For non-Medi-Cal clients, you can include no-show fees in contracts. For Medi-Cal clients, focus on prevention through reminder systems and clear communication about the importance of consistent care.

How do I get the licensed provider recommendation for additional Medi-Cal visits?Work collaboratively with your client's healthcare provider to obtain a recommendation for additional postpartum support. DHCS provides a template for these requests to streamline the process.

Can I provide multiple types of visits in one day?

No, you can only bill for one visit per day per client, except on the day of delivery. For example, you are allowed to bill for both labor support and an extended postpartum visit on delivery day if you stayed to offer support after your client gave birth.

What records should I maintain for insurance billing?Keep detailed records of visit dates, duration, services provided, and how you supported your client's well-being. Chart notes should focus on covered services and be thorough enough to support your billing claims during any potential audit.

Accepting health insurance and Medi-Cal as a doula in California represents an exciting opportunity to expand your practice while serving families who deeply need your support. Success comes from thoughtfully adapting traditional doula approaches to work within insurance frameworks while maintaining the client-centered, compassionate care that defines excellent doula work.

The transition to insurance acceptance might require some initial creativity and adjustment, but the long-term benefits are significant: predictable income, an expanded client base, and the profound satisfaction of making doula care accessible to diverse families throughout California. Remember, this isn't about changing who you are as a doula – it's about finding new ways to share your gifts while building a sustainable practice that can serve families for years to come.

‍