What's Covered: Visits and Details

• Initial consultation: an introductory meeting to get to know your doula, discuss your goals and concerns, and create a personalized care plan for pregnancy, birth, or postpartum.
   
• Up to 8 prenatal or postpartum visits: these are one-on-one sessions either before birth or after birth (or a mix of both, depending on your needs). Each visit is typically a hour-long (some may be virtual or in-person) focused on whatever you need – whether it’s childbirth preparation during pregnancy or lactation support after delivery.
   
• Continuous support during labor and delivery: your doula will be by your side throughout your active labor and birth, providing hands-on comfort and advocacy. (This includes support during labors that end in stillbirth, and support during experiences of miscarriage or abortion as applicable.)
   
• Up to 2 extended postpartum visits: these are longer visits (up to three hours each) after your baby is born, meant for extra help during those challenging early days. An extended visit gives time for things like overnight newborn care relief, deeper household support, or extended guidance with feeding and soothing the baby.

Each visit is limited to one per day per member – you and your doula will schedule the timing of visits in a way that makes sense for your recovery and lifestyle (for example, you might choose to space postpartum visits weekly, or use several prenatal visits in the last trimester). The benefit is quite flexible: if needed, a prenatal or postpartum visit can even occur on the same day as your labor support (for instance, if you meet your doula at home on the day you go into labor and then they continue to support you through the birth). Your doula will help you make the most of the allotted visits.

Note: For full details about eligibility, coverage limits, and any exclusions, please refer to your plan’s Evidence of Coverage (EOC) document or coverage booklet. Always check your plan documents for the complete list of covered services and policies. If you have any questions about what’s covered, WHA’s Member Services can help clarify.

Exclusions: Appointment Types Not Eligible

• Belly binding (traditional/ceremonial)
• Birthing ceremonies (i.e., sealing, closing the bones, etc.)
• Group classes on babywearing
• Massage (maternal or infant)
• Photography
• Placenta encapsulation

The doula benefit is more than just a health service – it’s part of the WHA community commitment to support you through life’s big moments and challenges. Whether it’s your first baby or your fourth, or whether you’re celebrating a new arrival or healing from a loss, we want you to feel the strength of a caring community around you.

Additional Doula Perinatal Visits

WHA members may receive up to nine additional postpartum visits beyond the 12 that are included in the doula benefit design. This will require recommendation from a WHA participating (contracted) physician or other participating licensed practitioner of the healing arts (e.g. nurse midwives, nurse practitioners, licensed midwives, behavioral health providers), acting within their scope of practice under state law. 

Criteria that may be considered for additional visits include the following:

• Maternal Physical Health Conditions, including but not limited to:
  • Pregnancy-Induced Hypertension
  • Gestational Diabetes Mellitus
  • Hypertensive Conditions, such as preeclampsia and eclampsia
  • Cardiovascular Conditions, such as cardiomyopathy or myocardial infarction
  • Hypercoagulable Conditions, such as deep vein thrombosis or stroke
  • Intensive Care Unit (ICU) Admission
     
• Maternal Behavioral Health Conditions, including but not limited to: 
  • Depression
  • Anxiety
  • Bipolar Disorder
  • Post-Traumatic Stress Disorder
  • Substance Use Disorder
     
• High-Risk Social Determinants of Health, including but not limited to:
  • Lack of Home Support
  • Housing Insecurity
  • Food Insecurity
     
• History of Adverse Birth Outcomes, including but not limited to:
  • Infant and Maternal Mortality
  • Preterm Birth
  • Low Birth Weight
  • Longer-Term Effects (e.g. motor, cognitive, visual, hearing, behavioral, social-emotional, health, and growth problems)
     
• Health Conditions of the Newborn/Infant, including but not limited to:
  • Neonatal Intensive Care Unit (NICU) Admission
  • Congenital Anomalies or Disorders
  • Feeding Difficulties
  • Neonatal Abstinence Syndrome 

Clinical Documentation

Along with recommendations from a participating physician or other participating licensed practitioner of the healing arts, a request for prior authorization is required for additional perinatal visits of up to nine visits. Prior authorization for the additional visit requests must be submitted to WHA’s Clinical Resources Department via one of the following methods:

Western Health Advantage
ATT: Clinical Resources
2349 Gateway Oaks Drive, Suite 100 | Sacramento, CA 95833
Email: CRIntake@westernhealth.com | Fax: 916-568-0278