* Two years ago, from Capitol News Illinois…
Gov. JB Pritzker signed a law Monday that expands insurance coverage during and after pregnancy with the goal of lowering infant and maternal mortality rates, especially for Black Illinoisans.
The law requires insurers that provide state-regulated health care plans to cover pregnancy and postpartum services for covered individuals, including midwife services, doula visits, and lactation consultants for up to 12 months after the end of a pregnancy. Licensed or certified midwives will need to be covered by insurance providers starting 2025, while all other outlined services must be covered by January 2026.
* But getting that coverage has been a struggle for some families. The Sun-Times reports…
Private insurers were supposed to be ready to cover doulas on Jan. 1, but the law is still missing key pieces. Families are paying the price, a WBEZ / Chicago Sun-Times investigation has found. […]
Blue Cross and Blue Shield of Illinois told [Eleanor Grano] there are only five doulas in their network for the entire Chicago area, according to messages Grano showed a reporter. In-network providers are typically cheaper than those out of network. And if Grano could stay in her network, the doula bills Blue Cross, not her.
But the five doulas didn’t work out. She learned she’d have to pay up front, then ask for reimbursement. The cost: around $10,000 for a month of overnight stays. Grano and Fagan feared they never would get paid back. […]
“Requiring patients to have thousands of dollars available up front creates a significant financial barrier to accessing a covered benefit,” Grano wrote. “As a woman of color, the law’s goal of addressing racial inequities in maternal health is also deeply meaningful to me.” […]
[Rep. Robyn Gabel, D-Evanston, a lead sponsor of the legislation,] says the bill she plans to file in January would require network adequacy for doulas.
“There needs to be a little more pressure to make sure that the insurance companies recruit doulas and make sure that they have doulas in their networks,” Gabel says.
- Katie - Thursday, Oct 22, 26 @ 10:57 am:
Had a very similar experience trying to access postpartum doula care on my State of Illinois Blue Choice plan earlier this year. Nearest provider was in Aurora (I live in Edgewater), and when I called BCBS to see if I could finagle partial coverage for an out-of-network doula the customer service rep had never even heard of a postpartum doula before, let alone plan coverage for one (to be fair, she was a total sweetheart and gave me some tips for rolling the dice on submitting a claim). In the end I just did one visit and ate the cost.
- Sue - Thursday, Oct 22, 26 @ 11:10 am:
The article is shocking, actually. Insurance is supposed to pay for medical care. Doula services were justified because during labor a doula may reduce complications. But now a family wants insurance to pay for a night nurse! And in the meantime, insurance companies get blamed for insurance premiums going up!
- Demoralized - Thursday, Oct 22, 26 @ 12:49 pm:
I’m absolutely shocked @Sue that someone would want their insurance to pay for medical care.
Our system is broken. This is why we need a nationalized system where everyone has access to the healthcare that they need.
But you keep on defending the status quo.
- Anon - Thursday, Oct 22, 26 @ 2:03 pm:
@Sue,
I think the important piece you’re leaving out is that insurance companies (e.g. BCBS of Illinois) are reporting record profits year after year. So yes, I do blame them for premiums increasing. They’re not hurting financially.
- Steve - Thursday, Oct 22, 26 @ 2:06 pm:
-Our system is broken. This is why we need a nationalized system-
I wonder if everyone will get the same care and people will be able to pick their doctor?
- Banish Misfortune - Thursday, Oct 22, 26 @ 2:25 pm:
Initially I was skeptical, I didn’t have a doula (etc, etc). What I had was a mother, but now they all work too. if we want to make it possible for women to work, the support for new mothers has to come from somewhere. Like care for the elderly, if both parents work, we have to make it feasible to do so.
- Excitable Boy - Thursday, Oct 22, 26 @ 2:27 pm:
- everyone will get the same care and people will be able to pick their doctor? -
This isn’t guaranteed under private insurance. If all the doctors are covered by a national healthcare plan I can’t see how your options would decrease.
- Juice - Thursday, Oct 22, 26 @ 2:59 pm:
I think the important piece that everyone seems to be overlooking is the fact that the family highlighted in the article is on the dad’s insurance, and he is a professor at UIC.
Which means he is on the State’s health insurance plan.
This doesn’t require legislation to fix in this scenario. It simply requires someone either in the Gov’s office or CMS to call their vendor (BCBS) and tell them to get their act together.
- Bigtwich - Thursday, Oct 22, 26 @ 3:27 pm:
Juice,
It’s not just the State’s health insurance plan. Read the Sun Times Article.
- Amalia - Thursday, Oct 22, 26 @ 6:47 pm:
just make sure they get to a doctor. supportive services are great, but doctor first.