BlueCross BlueShield of Illinois Doula Care Coverage

If you're a BlueCross BlueShield of Illinois member and expecting a baby, there's good news: doula care is becoming available in-network for eligible members. Partum Health is working directly with BCBS of Illinois to bring birth and postpartum doula support in-network, expanding access to critical support during pregnancy and postpartum.

We know navigating a new insurance benefit can be confusing, and we wish the process were simpler. Insurance coverage for doula care is still new and details are evolving, and we're working to get you the clearest information possible. This page walks through what we know today, how to check your own eligibility, and what the benefit includes if you're covered.

Does My BCBS Plan Cover Doula Care?

BlueCross BlueShield coverage for doula care varies state to state and plan to plan. In IL, coverage for some plans is required by law (the Birth Equity Act). Here's what determines whether your plan requires coverage:

• Where your plan is based: To access Illinois’s doula care benefit, you need a BlueCross BlueShield of Illinois plan specifically. Other BCBS plans (like Anthem, CareFirst, or Blue Cross plans from other states), follow different rules, and we work with each member to determine the best way to help them use their benefit
• How your plan is funded: Your plan needs to be fully insured, which means you or your employer pay a fixed premium to the insurance company, and the insurance company is responsible for the cost of your care. Fully insured plans are regulated at the state level, and therefore states can require specific areas of coverage. It is estimated that ~30% of BCBS of Illinois members are on fully insured plans. 
  
  • Marketplace plans are fully insured. If you bought your plan through healthcare.gov or the Illinois marketplace (Get Covered Illinois), you likely have a doula care benefit. 
  • Employer plans vary. In general, it is more likely that smaller employers (<100 employees) will have a fully insured plan. Larger employers typically have a self-funded BCBS plan, or ASO. This means they pay BCBS an administrative fee but cover the healthcare costs themselves, so a doula care benefit is not required but could be added by the employer.

Most people don't know offhand whether their plan is fully insured, and that's completely normal. The good news is you don't need to figure that out yourself before checking benefit details.

How to Verify Your Benefit

Right now, the most reliable way to confirm your benefit is to call BlueCross BlueShield directly and ask if your plan includes coverage for doula care. Share your information below, and we'll send a script to make your call easy.

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Before you hang up, ask for written confirmation of your benefits. Securing this documentation, along with a call reference number, establishes a paper trail that can b helpful for resolving potential post-care billing discrepancies.

Once you've verified your coverage, we can help you understand all of your options for paying for doula care, including matching you with an in-network doula.

What Does the Benefit Cover?

We want to be upfront that this benefit is still taking shape. Based on our current understanding of how BCBS is structuring this benefit:

• Approved members can expect a maximum of 32 visits of doula care with an in-network doula as part of their benefit. The aim is to support you throughout your pregnancy, birth, and postpartum period. To the best of our knowledge, BCBS is still determining the specifics of this coverage, including benefit maximums and applicability of copays and deductibles. 
• BCBS will also cover support during labor and delivery, though they are also finalizing the specific guidelines for coverage and reimbursement, and the benefit structure may change over time. 
• At Partum, if and when you reach your maximum benefit amount, you will have the option to continue support with a cash pay rate using your HSA/FSA or paying out of pocket. If you decide to extend beyond the hours covered by your insurance, we'll always talk you through the cost before anything is billed to you, so there will be no surprises.

Because BCBS hasn't finalized these details across all plans, treat the numbers above as our best estimate rather than a guarantee. BCBS member services can confirm exactly what applies to your specific plan.

How to Get Started

1. Call BCBS of Illinois to confirm you have a doula benefit, and get that confirmation in writing.
2. Reach out to Partum Health — we'll match you with one of our in-network doulas based on your due date, location, and preferences. You can get started here.
3. If an in-network doula isn't available for your dates, we'll talk you through your options, including working with a Partum doula through an out-of-network exemption.

What If You Don't Have an In-Network Doula Benefit?

Not every BCBS plan will have an in-network doula benefit. If your call to member services confirms there's no in-network doula coverage available to you, that doesn't mean you're out of options, and we're happy to help you figure out what's available to you.

Some BCBS plans include out-of-network (OON) benefits, which can partially reimburse you for care, including from a Partum doula. To use this option, you'd pay Partum directly for care, then submit a superbill (an itemized receipt with the information your insurance needs) to BCBS for reimbursement.

A few things to know about this path:

• When you call BCBS to check your doula benefit, it's worth asking specifically about your out-of-network benefits and what they'd reimburse for doula care.
• You'd pay Partum's standard rates upfront and submit your superbill and a claim for reimbursement afterward.
• Reimbursement amount, and whether you have an out-of-network deductible to meet first, depends on your specific plan.
• Partum can provide the superbill you'll need, but can't guarantee what BCBS will ultimately reimburse.

If you have insurance through an employer and the plan is self-funded, doula coverage generally depends on whether your employer has specifically opted into that benefit, and it’s  worth checking with your HR or benefits team. It's also worth asking whether your employer offers a separate doula or fertility benefit through a program like Carrot Fertility, Maven, or Progyny, which some employers provide alongside standard health insurance.

Wherever you land, our team is happy to talk through what makes sense for your specific situation.

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Frequently Asked Questions

Does BlueCross BlueShield cover doula care in Illinois? Yes, for some members. The most likely to have coverage are those with a fully insured BlueCross BlueShield of Illinois plan. Partum Health is working to bring doula care in-network with BCBS of Illinois, with more Partum Health doulas joining the network on an ongoing basis.

How many hours of doula care does BCBS cover? Because BCBS is still finalizing the benefit structure, we don’t have an exact number to provide. We will work with whatever guidance is provided to you in writing. Once the benefit structure is finalized, we expect members will be eligible for approximately 28-33 hours of combined prenatal, birth, and postpartum doula support. This is an estimate based on our work with other insurance providers.  

How do I find out if my plan includes a doula benefit? Call the member services number on your insurance card and ask specifically about doula care coverage using the guidance above. Ask for written confirmation of your benefit.

Coverage for doula care is new and still taking shape, but it's a real and growing payment option for BCBS of Illinois families. Whether you're covered through insurance, FSA/HSA, an employer benefit like Carrot, or paying out of pocket, Partum Health can help you find the right doula for your family.