#84. Stop Overpaying! Maximize What Your Insurance Covers for Birth & Beyond
- Clara O'Rourke
- Apr 8
- 4 min read
When preparing for birth, most families budget for hospital bills, but did you know your insurance may cover much more? From childbirth education and lactation support to postpartum recovery and mental health care, there are hidden benefits in many health plans that could save you thousands of dollars.
In this episode, we break down:
✅ The essential birth & postpartum services your insurance may cover
✅ Key CPT codes to use when calling your provider
✅ How to get reimbursed for childbirth classes, doulas, and lactation care
✅ What to do if your insurance denies coverage—and how to fight back
Listen to the episode now:
When preparing for childbirth, many families focus on budgeting for hospital bills and medical expenses. However, did you know that your insurance may cover much more than just hospital birth costs? Childbirth education, lactation support, postpartum recovery, and even mental health services are often included in health insurance policies, but many families are unaware of these benefits.
In this blog post, we’ll break down how to ensure you’re getting the most out of your insurance plan, saving money, and securing the essential support you need throughout your childbirth journey.
Why Insurance Benefits Matter for Birth and Postpartum Care
Studies have shown that comprehensive education, skilled lactation support, and adequate postpartum care significantly improve birth outcomes and long-term health. Unfortunately, insurance companies don’t always make it easy to identify what’s covered. If you don’t advocate for yourself, you could end up paying thousands of dollars out of pocket for services that should have been covered.
Let’s go step by step through the essential services your insurance may cover and how to ensure you receive those benefits.
1. Childbirth Education Coverage
Many insurance plans cover evidence-based childbirth education classes, whether online or in person. To check if your plan covers childbirth education:
Call your insurance provider and ask if CPT Code S9436 is covered.
Many plans allow you to pay for classes with a Health Savings Account (HSA) or Flexible Spending Account (FSA), offering tax savings.
If covered, you may need to submit a certificate of completion or receipt for reimbursement.
2. Lactation Support and Breastfeeding Assistance
The Affordable Care Act requires most health plans to cover lactation support. This can include:
Home visits, clinic visits, or virtual consultations with an International Board Certified Lactation Consultant (IBCLC).
To check for coverage, ask about CPT codes 99404 (preventative counseling) and S9443 (lactation classes).
Some plans require pre-approval, so verify if you need a referral from your provider.
3. Doula Support: A Growing Benefit
Doulas provide valuable labor and postpartum support, and some states now mandate Medicaid and private insurers to cover their services.
Check if your state includes doula support under Medicaid or private insurance. In Massachusetts, for example, MassHealth covers birth doula support.
Employers offering family support programs (such as Carrot in tech industries) may cover doula services.
Ask your insurance provider if birth or postpartum doula support is considered a preventative service under your plan.
4. Postpartum Recovery Essentials
Many postpartum recovery items may be covered under Durable Medical Equipment (DME). These include:
Breast pumps (various models are often covered; check through third-party providers that help do the work for you for free like Aeroflow).
Pelvic floor therapy (to address incontinence, pain, or diastasis recti):
Check CPT codes 97110 (therapeutic exercises) and 97112 (neuromuscular reeducation).
Some plans require a provider referral for coverage.
Postpartum belly wraps or perineal care items may also be eligible for coverage.
5. Mental Health Support for Birth and Postpartum
Postpartum anxiety, depression, and birth trauma therapy are often covered under maternal mental health services. To access support:
Contact your insurance provider and ask about perinatal mental health services.
Organizations like Postpartum Support International (PSI) offer helplines and can help you find insurance-covered providers.
English Helpline: 1-800-944-2733
Spanish Helpline: 1-800-944-4773
Actionable Steps to Maximize Your Insurance Coverage
Call Your Insurance Provider – Ask what childbirth education, lactation support, and postpartum services are covered. Provide the CPT codes mentioned above for clarity.
Check Your Summary of Benefits – This document, available on your insurer’s website, outlines what’s covered under maternity and postpartum care.
Get Pre-Approved (if required) – Some services require a doctor’s referral before being covered. Be proactive in obtaining approvals.
Submit Reimbursement Claims – If you’ve already paid for services, keep your receipts and check whether you can submit them for reimbursement.
Check Employer and Medicaid Benefits – If you have workplace insurance, verify if HSA/FSA funds can cover birth-related expenses. Medicaid programs in certain states now cover doulas, home births, and lactation support.
Appeal Denied Claims – If your insurance denies coverage, appeal the decision. Many families receive reimbursements after advocating for their needs.
Review Hospital Bills – After giving birth, request an itemized bill to ensure you aren’t charged for services or medications you didn’t receive.
Advocate for Your Coverage!
Your insurance is a tool, but it only works if you know how to use it. Many families miss out on valuable benefits simply because they aren’t aware of them.
Take action today by calling your insurance provider and ensuring you maximize your benefits. If this information was helpful, share this blog with expecting parents so they, too, can save money and receive the care they deserve.
And if you’re looking for a childbirth class that’s reimbursable by insurance, check out my course, A Path to a Powerful Birth, available both online and in person at www.clearlightbirth.com/classes.
Let’s make sure you get the most out of your insurance and have a supported, informed, and empowered birth experience!
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