Welcome
At Loula, we're on your side. You do the hands-on work of supporting families, and we handle the billing so you can focus on care.
Billing through insurance comes with rules, and they can feel unfamiliar if you're used to working privately. These policies take the guesswork out of it: when everyone follows the same standards, claims get paid faster and clients are protected. This is how we help you stay compliant, so you can keep taking health insurance with confidence.
If anything here is ever unclear, reach out. We'd much rather answer a question early than sort out a problem later.
What this guide covers
This guide explains how to submit visits for reimbursement, what documentation to keep, and the few things to avoid. It applies to everything you provide through the Loula platform, across Medi-Cal managed care plans and every other plan in our network.
It works alongside the Loula agreement you signed and each plan's billing guidance. This is the plain-language version that should answer most of your day-to-day questions.
One resource worth knowing about: there's a family-facing booklet that explains the doula benefit to clients in plain language, what's covered, how visits work, and what to expect. It's a good thing to share when a client is unsure how their coverage works. You'll find the family benefit booklet at the Loula Help Center.
A few terms worth knowing
You don't need to memorize these, but they'll come up throughout the guide:
Date of service: the actual day you provided care.
Rendering provider: the doula who personally delivered the service.
Covered service: a service included in your client's insurance benefit.
Non-covered service: a service that falls outside their benefit.
Clean claim: a complete, accurate submission that doesn't need follow-up to get paid.
Balance billing: charging a client the difference between your usual rate and what insurance pays. This is never allowed, and we explain why below.
Recoupment: when a payment made in error has to be paid back.
Policies at a glance
Here's every policy in one line. The rest of the guide expands on each one. If a one-liner is all you need, you're good. If you want the why and the how, read on.
Set the client up right
6. Ask whether the client has seen another insurance doula this pregnancy, and log any prior visits.
Put it in writing
Bill accurately and keep records
Follow the visit rules
20. For a home birth, bill only if a licensed medical professional is present, and report their NPI.
Protect your clients
How things work day to day
This guide in action: how to submit a clean claim
The policies, expanded
Most of these come down to one idea: bill accurately for the care you actually provided. Here's each policy in full.
Set the client up right
1. Don't serve a client through Loula for a plan until your credentialing start date is confirmed.
For some plans, you'll be credentialed right away, at the same time as your Loula approval. But credentialing with a health plan can often take time, sometimes up to six months. Until you have a confirmed credentialing start date with a plan, don't begin serving clients through Loula under that plan. And once you're credentialed, Loula will only bill for visits on or after your start date. You can always check your Loula portal for your credentialing status.
Example
If your start date with a plan is February 1, a visit on January 28 can't be billed. Waiting for the confirmed date protects you from doing work that can't be paid.
2. Verify every client's insurance through Loula before the first visit.
Always verify a client's insurance through Loula before you provide any services. To do this, add the client in your portal, and Loula automatically kicks off the insurance check from there. Do this first, before the first visit. It confirms the client is eligible and saves everyone from problems later.
Waiting for verification isn't just a formality. If you provide visits before a client's insurance is verified, and it turns out their coverage wasn't active, or the plan denies it for another reason, those visits can't be billed. There's no way to recover payment after the fact, so the loss falls on you. Verifying first is what protects your time from being unpaid.
If anything comes back unclear, reach out to us before getting started.
Ask whether the client has more than one insurance plan. Many do: employer insurance with Medi-Cal as secondary, two commercial plans, or a parent's or spouse's plan alongside their own. If there's a second plan, collect cards and details for both, including the subscriber's information if the plan is under someone else. Loula needs all of it to verify coverage and submit claims correctly, so share it when you create the client in the portal.
3. Keep the first intro call free and 15-30 min!
Start with a free intro call, a quick 15-30 minute call to get to know each other and see if you're a good fit. This is never billed. Many clients are still comparing doulas at this point, so treat it as exactly that: free, and with no commitment.
Set the expectation at the start. Open the call by saying how long it is and what happens if they want more. Something like:
"I've got 15 to 30 minutes for this call to see if we're a good fit. If you'd like a longer conversation after that, it would be a covered visit, billed to your insurance at no cost to you."
Don't extend the call on the spot. If they want to go deeper, don't continue the conversation, that's how a free call quietly turns into a billed one the client didn't expect. Instead, close by offering to follow up:
"If you'd like to keep going with a longer conversation, I'll send you a message with the details."
Then confirm in writing. Send a message offering the longer session, and decide what you want to offer, a 30-minute or hour-long call, by phone or in person. Spell out that it's a covered visit billed to their insurance at no cost to them, and wait for their clear yes before you book or bill it. That written exchange is also your record that they agreed.
Before you bill that visit, two things need to be in place:
the client has completed their electronic consent (see the electronic consent policy),
they've given the written yes above.
A full signed contract isn't required for this one deciding visit, but it is required before ongoing care begins (see policy on the client contract). The written agreement covers this single visit; the contract covers everything after.
Never turn a free intro call into a billed visit after the fact. The first billable visit only happens when the client has knowingly agreed to it in advance.
This is the single most common source of disputes: a client thinks they're still shopping around, then gets a notice that a visit was billed. Setting the expectation up front and confirming in writing is what prevents it.
We explain this same two-step, a free intro call, then an optional covered visit, to families in the family benefit booklet on the Loula Help Center, so what they've read matches what you offer.
Free Intro Call vs Billable Visit
The free intro call is about deciding whether to work together. The first billable visit is where the work begins. A rough guide:
Free intro call (15-30 min) | First billable visit (a covered visit) |
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4. Make sure your client has completed their electronic consent before you begin.
Every client has to agree to receive electronic communications from Loula before you can submit visits for them. Loula sends this consent automatically, as a Welcome Email to the client when they're added, so it isn't something you complete yourself. But it is something you need to confirm is done before you start seeing the client, so you're not providing visits you can't yet submit. If the client hasn't responded, you can nudge them: open their Client Profile and use "Send Reminder Email" in the alert at the top. Once they've consented, you're clear to begin. For more on how client consent works, see electronic consent in the handbook.
5. Have a signed contract with your client before ongoing care begins.
A written contract is one of the strongest protections you have. It should lay out which services you'll provide, what gets billed to insurance, and what doesn't. Spelling this out up front means your client knows what to expect, and if a client ever disputes a visit or what was agreed to, the contract is what you point to.
Here's the timing. After your free intro call, you can offer one billable visit to help a client decide (see policy 3). That single deciding visit is covered by the written agreement from your intro-call follow-up, so you don't need a signed contract for it.
But once a client decides to work with you, get the contract signed before ongoing care begins, that is, before any visits beyond that first one. Share it as soon as they're ready to move forward, so they can review everything before they commit.
Tip · Use two contracts, up front
Offering anything outside the benefit, like belly binding or photography? Keep it separate:
One contract for covered services, billed to the plan.
One for non-covered services, whether you charge for it (at a set price) or offer it for free. Either way, it's handled outside insurance, and covered visits stay separate and free to the client.
Set this up from the start. Never spring a charge partway through, or present an extra as part of their benefit. For more, see how to discuss non-covered services with your clients.
One caution worth knowing: most sample doula contracts you'll find online are written for cash-pay work, not insurance-covered care. They won't reflect how Medi-Cal billing works, so be careful adapting one to your Loula clients. If you're unsure whether your contract covers the right ground, reach out to us.
6. Ask whether the client has seen another insurance doula this pregnancy, and log any prior visits.
When you take on a client, ask whether they've worked with another doula who accepts insurance during this pregnancy. If they have, those visits count toward the plan's limits, even though you didn't provide them.
Get specific about what kind of visits they were, since each type draws down a different part of the benefit. Ask whether the prior doula billed a 90-minute intake, any of the eight standard perinatal visits, a labor and delivery visit, or an extended postpartum visit.
Log each one in the portal as an off-platform visit, with the dates and the previous doula's contact information if you can get it. This keeps the visit count accurate.
If prior visits aren't logged, you may end up submitting visits that get denied for frequency limits, and Loula can't pay for those.
Example · Picking up a client mid-pregnancy
A client comes to you at 30 weeks. She tells you she worked with another doula early on but they parted ways. Here's how you keep it clean:
Ask what that doula billed: the 90-minute intake? How many of the eight standard visits? Any extended postpartum?
Say she had the intake and four standard visits. That leaves four standard visits and the intake is gone, you can't bill a second intake.
Log those five prior visits in the portal as off-platform visits before you submit your own.
Now bill your visits against what's actually left, not a fresh count of eight.
Skip the logging, and your fifth standard visit looks fine to you but gets denied, because the plan already paid the first doula for those four.
Put it in writing
7. Confirm every appointment in writing, by text or email.
After you schedule a visit, send a quick written confirmation: a text or email noting the date, time, and type of visit. Keep these. If a client ever disputes that a visit happened, a written confirmation is the proof that backs up your claim. It only takes a moment and it protects you down the line.
8. Get written consent and a clear price before charging for anything insurance doesn't cover.
If a client wants a service that isn't covered and you'd like to charge for it, you can, but only if you're up front about it first. Before you provide the service, you must tell the client, in writing, that it isn't covered by their insurance, and get their written agreement to pay, with the price made clear ahead of time.
Keep consent specific to the actual service. Never use a blanket waiver covering "anything and everything."
Example · A client wants placenta encapsulation
❌ Not Compliant: You provide it and add it to the visit you bill to insurance, or you fold its cost into your covered visits so it's "included."
✅ Compliant: You write it into a separate contract as a non-covered service, whether you charge for it (at a set price) or offer it for free. Either way, it's handled outside insurance, and her covered visits stay separate and free to her.
Note
Check out Loula's Handbook for more details on services that are covered and not covered by insurance.
Bill accurately and keep records
9. Always bill the real date of service.
Always enter the actual date you provided care. Never move a date earlier or later, even for catching up on submissions. Health plans check dates against their own records, so an accurate date keeps your claim clean and avoids questions down the line.
10. Bill under the doula who actually did the work.
The provider listed on a visit must be the person who actually provided the care. Never submit a visit under your name for work someone else did.
We strongly recommend that your backup doula also be credentialed through Loula, so that you can easily share the client and we can take care of paying the back up doula.
However, If a backup doula covers for you but is not credentialed with your client's plan, you must pay them directly for their time rather than billing it to insurance OR the back up doula will have to make their own arrangement. Be sure to document this with your backup doula and the client in advance.
Never bill insurance for services another doula rendered as though you provided them yourself.
11. Bill each client under one contract only, Loula or your own, never both.
You're welcome to have your own contracts and bill clients directly, in addition to working with Loula and billing through us. Loula and health plans aren't exclusive, so both paths are open to you.
That said, please keep in mind that you can't bill for the same client through multiple channels. For example, if you start billing for a client under your own contract, she can't later be moved onto Loula's billing, and the reverse is true as well.
This holds even if billing under your own contract was unsuccessful. If your claims were denied, delayed, or you were never paid, the client still can't be moved to Loula, not even to try again through us.
Once a client is billed under one channel, that's the channel for the rest of her care. This matters because health plans may flag claims as fraudulent if a client is billed through more than one channel. For this reason, Loula isn't able to help with billing for any client who has already been billed, or had billing attempted, through another channel.
Example
You billed a client's first three visits under your own Kaiser contract, but two came back denied and you're getting nowhere.
It's tempting to move her to Loula and re-bill through us instead. You can't. She started under your contract, so she stays there. Re-billing the same visits through Loula would mean two contracts billing for one client, which is exactly what plans flag as fraud.
12. Only bill insurance for covered services.
Insurance can be billed for services that are part of your client's doula benefit. Across Medi-Cal and Kaiser, that generally includes a 90 min initial intake visit, additional prenatal and postpartum visits up to the plan's limit, labor and delivery support (once per pregnancy), extended postpartum visits, and support around a miscarriage or abortion, where applicable.
Some wonderful services that doulas offer simply aren't part of the insurance benefit, things like belly binding, birthing ceremonies, massage, photography, placenta encapsulation, vaginal steams, and group classes. You're welcome to offer these services, including for free if you'd like. Never submit them to insurance.
Note
Check out Loula's Handbook for more details on services that are covered and not covered by insurance.
13. Keep clear notes and proof of every visit you bill.
For every visit you bill, write down a few notes while it's fresh. Your notes must capture:
The date and how long the visit lasted
What kind of support you provided (for example, prenatal education, birth planning, labor support, or postpartum check-in)
Enough detail to back up the visit you're billing
They don't need to be long. Something like "Met with client for one hour to talk through childbirth education and start a birth plan" is plenty. Submit your notes through the Loula platform with each visit. For a longer guide to charting well, "Best Practices for Visit Notes" in the Loula Handbook.
Warning · Keep these out of your notes!
Each of these can get a claim held or denied:
Non-covered services. Never note a non-covered service in the same place as a covered one. Keep extra support in a separate record.
Medical language. Avoid words like diagnose, prescribe, or administer. Describe what you did, not what a clinician would do.
For every visit you bill, you need something in writing that shows the visit was real. This is required. It's your protection if a client ever disputes that a visit happened.
Before a visit, the simplest proof is a quick confirmation: a text or email with the date, time, and type of visit. For a visit that happens ad hoc, with no time to confirm ahead, create the written record afterward instead.
The easiest way to cover yourself, and the one we recommend, is a short follow-up after each visit: a recap of what you covered, a "next steps" note, or even a quick "great seeing you today."
It's good client care and it gives you a timestamped record that you both connected. If a visit happens by phone with nothing else to show for it, keep your call log too.
14. Submit every visit in the cycle it happened or the next one.
Submit each visit through the Loula platform as soon as you can after the appointment. The deadline is the end of the cycle the visit happened in, or the end of the very next cycle. Loula's cycles are semi-monthly: the 1st to the 15th, and the 16th to the last day of the month. So a visit on February 11 falls in the first February cycle, and your last chance to submit it is February 28, the end of the next cycle. After that, the visit can't be submitted.
Submitting on time is the best way to make sure your work gets paid, so when in doubt, send it sooner. See "How and when you get paid" for the full cycle and payment timing.
Follow the visit rules
15–18. Visit limits
Health plans limit how often visits can be billed, and following these limits keeps your claims clean.
The basic rule is one billable visit per client per day, submitted by one doula. The one exception is delivery day: on the day of labor and delivery, you can bill a prenatal or postpartum visit on top of the labor and delivery support, and those two can even be billed by different doulas. That's useful when a backup steps in for part of the day.
Extended postpartum visits are limited to two per pregnancy, on separate days. Support around a miscarriage and support around an abortion are each billed once per pregnancy.
19. Get a written recommendation before billing the nine additional postpartum visits.
Most doula care does not require a recommendation. The Department of Health Care Services has issued a standing recommendation for doula services, which means Medi-Cal clients do not need prior authorization or an individual referral to receive their standard doula benefit. You can begin providing covered care without one.
There is one exception. A Medi-Cal client who needs the nine additional postpartum visits available to them does need a written recommendation from a licensed practitioner for those specific visits. That practitioner can be a doctor, nurse, licensed lactation consultant, licensed therapist, or another licensed provider acting within their scope. This recommendation must be on file and uploaded to the Loula portal before those additional visits can be billed. It cannot be a standing order. It has to be written specifically for that client.
20. For a home birth, bill only if a licensed medical professional is present, and report their NPI.
Loula supports doula care at home births with one condition: a licensed medical professional, like an OB-GYN or certified midwife, must be present. When you submit the visit, include that professional's NPI number.
A couple of things to check first. Confirm your professional liability insurance covers home birth support, since not all policies do. If yours doesn't, we recommend either getting coverage that does or not providing home birth support. And note that Loula can't be held liable for complications that arise during a home birth.
Please note: at this time, Kaiser commercial insurance does not currently allow coverage for ANY home births.
Protect your clients
21. Never ask for upfront deposits or payments on covered services (No balance billing!)
Balance billing means charging a client extra to make up the difference between your usual cash-pay rate and what the health plan reimburses for a covered service. Never do this, for any insurance member, on any plan, Medi-Cal, Kaiser, or anything else in our network. Balance billing is illegal on both the state and federal level!
Here's the reasoning: when you take part as a contracted provider, you're agreeing to accept the contracted rate as full payment for covered services. That agreement is the whole point of the contract from the health plan's side. Charging the client for the gap goes against both the regulations and the agreement you signed with us, even when the contracted rate is lower than what you'd normally charge privately. The client can never be billed for that difference. This holds even if the client signs a waiver agreeing to pay. A waiver does not make balance billing allowed.
This is one of the biggest differences from private, cash-pay work, and it's where habits from that world get you into trouble. Deposits, retainers, and asking a client to cover a gap are all normal when someone pays out of pocket. With insurance, none of them are allowed, and that's true for commercial clients just as much as Medi-Cal. It's tempting to treat a commercial client more like a private one, but a covered client is a covered client. If the service is covered, the plan's payment is the whole payment.
One related point on covered services. On-call time and travel time that are part of a covered visit are already included, so never bill the client separately for them, and never charge a standalone on-call fee or retainer, on any plan. (Cancellations and no-shows are a different case, see policy 22.)
Note
Check out Loula's Handbook for more details on services that are covered and not covered by insurance.
Example · The habit that trips people up
In her private practice, one doula always took a $500 deposit at signing, standard, professional, and it protected her time. When she started taking insurance clients through Loula, she kept doing it, because it felt like good practice.
It's not allowed. For a covered client, the visits are paid in full by insurance, so there's nothing for a deposit to go toward. Asking for one means charging the client for covered care, which is balance billing, even though she meant nothing by it and fully intended to "apply it" later.
The same is true for commercial clients. It's easy to assume a commercial plan works more like private pay, but a covered client can't be asked for a deposit or a retainer, whatever their plan.
22. Watch out: cancellation and no-show fees have strict rules when it comes to insurance.
A missed or last-minute visit is time you set aside that can't be offered to anyone else, and it can't be billed to insurance. What you can charge the client depends on their plan, so find the part that applies.
First, two quick definitions:
A no-show is a scheduled visit the client doesn't attend, with no notice.
A late cancellation is a visit cancelled with less than 24 hours' notice. Ask clients for at least 24 hours' notice to reschedule.
For Medi-Cal clients
No charge, ever. Medi-Cal rules don't allow you to charge for a missed visit or a late cancellation, and you can't bill the client for it. This holds even though the visit isn't reimbursed.
Keep a record of missed and late-cancelled visits in the client's file.
You're allowed to create a no-show/late cancellation policy that works for you, but that does NOT charge the client. For example, you can implement a rule like, "Our engagement will end if there are 2 or more no-shows," but make sure that this is written in your agreement with your client. If you do end your relationship with the client, notify Loula at [email protected] so that we can find another doula to support them.
For commercial clients
Any cancellation or no-show fee must explicitly be in your contract with the client and agreed upon in advance. You cannot charge these later if they weren't originally agreed upon.
Your policy needs to spell out:
how much the fee is
whether you require 24 or 48 hours' notice
that the fee is the client's responsibility and is never billed to insurance
Decide how you'll actually collect it. This is hard to do after the fact, so if you plan to charge a fee, arrange a way to collect it, like a card on file, in advance.
(On-call and travel time follow a different rule, see policy 21.)
23. Never perform clinical tasks.
Clinical and medical tasks are outside a doula's scope of practice, and you should never perform them for your clients. This includes things like taking blood pressure, checking fetal heart tones, performing vaginal exams, or any other clinical or medical procedure. Doulas aren't trained or credentialed for clinical care, and providing it puts both your clients and your standing at risk. This isn't a question of billing. These tasks should never be done at all. If a client has a clinical need, refer them to the appropriate medical provider.
How things work day to day
Submitting a visit
Submit each visit through the provider portal as soon as you can after the appointment. Here's the flow:
Fill in the date, the type of support, and how long the visit lasted.
Add your notes from the visit.
Confirm it happened as described and that everything is accurate. That confirmation is your sign-off on the claim.
Submit by the end of the cycle the visit happened in, or the end of the next cycle. Sooner is always better.
If you're ever unsure whether something is billable, ask us before submitting.
How and when you get paid
Loula's pay cycle runs in two halves each month: the 1st to the 15th, and the 16th to the last day. There's a two-cycle delay between submitting a visit and getting paid for it.
Submit between the 1st and the 15th, and you're paid on the 15th of the following month.
Submit between the 16th and the end of the month, and you're paid on the last day of the following month.
So a visit on February 11, submitted in that same cycle, is paid on March 15. Submitted in the grace cycle (February 16 to 28), it's paid March 31. Either way, February 28 is the last day to submit a February 11 visit.
The delay exists because health plans take time to pay claims, sometimes 30 days or more. Loula's schedule absorbs that wait so your deposits stay predictable, even when an insurer is slow.
Tip · If you catch a mistake
Realized you got something wrong on a visit or a claim? Tell us as soon as you notice. Email [email protected] with as much detail as you can: what happened, and a screenshot of the claim if you have one. We'll help figure out the fix. The sooner you flag it, the more we can do, so don't sit on it.
If you miss the window: backlog visits
Sometimes a visit can't be submitted the normal way, either because it happened before you were credentialed with Loula, or because it missed the submission window. For Kaiser and Health Net clients only, you may be able to submit it as a backlog visit.
A few things to know before you rely on this:
It's for Kaiser and Health Net clients only. It isn't available on other plans.
You can go back up to 60 days, and only if your credentials (Medi-Cal enrollment, liability insurance, CPR, and so on) were valid at the time of the visit.
You're responsible for making sure the client's insurance was active on the date of the visit, not just today. Loula confirms current coverage, but past coverage is on you to verify with the client and the plan.
Payment isn't guaranteed on the regular cycle. A backlog visit is paid only if and when the health plan accepts the claim, which can take 30 to 90 days.
Access is granted case by case, for a limited window, by request. Because backlog visits are slower and less certain, they're a safety net, not a substitute for submitting on time.
When you submit on cycle, your payment is predictable. When you backlog, it isn't. The best protection is still to send visits in as they happen. For how to request the feature and submit a backlog visit, see backlog visits in the handbook.
When a backup doula steps in
Backup support is a normal part of this work. Here's how to handle it cleanly:
First, check whether the backup doula is credentialed with your client's health plan through Loula
If they are, they can add the client on the Loula portal as a shared client
If they aren't, pay them directly for their time rather than billing insurance for it
Either way, note in your records who provided the care
Talking with clients about non-covered services
If a client asks about something outside their doula benefit, be upfront before you provide it: let them know it isn't covered, that you're happy to provide it but it won't go through insurance, and what it will cost. Get their okay in writing and keep a copy. And if they're asking about something outside the doula scope altogether, like clinical care or lactation consulting, point them toward the right provider rather than taking it on yourself.
Note
Check out Loula's Handbook for more details on services that are covered and not covered by insurance.
This guide in action: how to submit a clean claim
Every policy in this guide is really working toward one thing: visits that get paid, without a problem down the line. Before you submit a visit, run this quick check. If all six are yes, you're in good shape to bill. If any is no, sort it out first, or the visit may be denied, delayed, or unpayable.
✅ Clean claim checklist
Credentialed with this client's plan.
Insurance verified, and active on the visit date.
Client electronic consent complete.
The visit happened by phone, video, or in person (not by text), and was a covered service.
One visit that day (delivery day excepted), backed by notes and proof.
Submitted on time.
This check covers the most common reasons a visit runs into trouble. It isn't everything, every policy in this guide still applies, but if these six are solid, you've avoided the problems we see most.
If your client disputes a visit
Sometimes a client questions whether a visit happened, or how it went. When that happens, we run an internal review called "Visit Verification." The goal is simple: get the full picture from both sides before any claim moves forward.
Here's how it works:
First, we pause. Any visit tied to the dispute is held, and the claim won't go to the health plan until the review is done.
Then we reach out to both of you, around the same time for Visit Verification. We'll ask the client for their account and any documentation they have, like texts or messages. We'll ask you for the same: your side, your visit notes, and anything that supports the care you provided. This is exactly why the habits earlier in this guide matter.
❗Important
Written appointment confirmations, a follow-up recap or other proof the visit happened, visit notes written close to the time, and a signed client contract are what let us back you up.
Finally, we review everything and let both parties know where it lands. The claim moves ahead, gets a small fix, or is voided. We document every step of the review, so there's always a clear record of how the decision was reached.
If a visit was already paid and the review finds it shouldn't have been billed, recoupment may apply. We'll always walk you through it first.
If you disagree with the outcome, tell us in writing within 14 days and we'll take another look.
Guaranteed payment vs. recoupment
Loula's promise is simple: if a client was verified when you submitted the visit, we pay you, even if the health plan denies the claim. When a properly verified visit is denied by insurance, that's our loss to absorb, not yours. You keep your payment.
That guarantee covers insurance denials. It doesn't replace your part: following this guide and keeping proper documentation for every visit. The guarantee protects you when the plan says no. Your records protect you when a client disputes a visit (see previous section for more on visit disputes).
Recoupment, when we take back a payment we already made, is extremely rare. It comes up in one main situation: a client disputes a visit, the review can't confirm it happened, and we'd already paid you for it. This triggers the dispute process outlined in the previous section. In that case, the payment may be reversed.
That's where your documentation makes the difference. A written confirmation, a follow-up recap sent to your client, and clear visit notes are often what let us confirm the visit and close the dispute in your favor.
When recoupment does happen, you'll always hear from us first. We'll explain which visit, why, and how the adjustment will be handled before anything comes out of a future payment. You'll never just see money disappear.
If we flag a visit
Separate from a client dispute, sometimes we'll need to pause and review a visit ourselves, or ask you a question about one. Usually that's because a health plan has a question. If that happens:
Take a look at our note. It'll explain what we're asking about
Send over any supporting documentation through the portal
We'll review it and let you know whether the claim can move ahead, needs a small fix, or has to be voided
If you don't agree with our call, let us know in writing within 14 days and we'll take another look
When we reach out with a clarification request, respond within 48 hours. That keeps your payment on the current cycle. Miss the window and the affected visits move to the next cycle's payment.
If a health plan ever audits or asks for records on claims you submitted, we'll coordinate the response with you. All we ask is that you cooperate and get us what's needed on time. We'll be right there with you through it.
Consequences
We'd always rather coach than penalize. Most issues get sorted out with a quick conversation and a small correction. But some things are serious, and to protect the whole network, we treat them that way.
What we do depends on what happened, how serious it is, whether it's come up before, and whether you flagged it yourself. Our response might include:
A written heads-up, and some retraining where it helps
Paying back any amount billed in error (recoupment)
Pausing your ability to take new clients or submit claims while we look into something
In the most serious cases, ending the provider agreement
A few things sit at the serious end: billing for care that didn't happen, charging clients for covered services, and intentionally misrepresenting a claim. These can put your standing with Loula and the health plans at risk.
Whenever a concern comes up, here's what you can expect from us. We'll tell you in writing what we found and what we're proposing. We'll give you 14 days to respond or share your side. We'll review what you send, then let you know where things land. If a payback is involved, we'll explain the amount and how it works before anything comes out of future payments. Ending an agreement only happens with written notice, according to the terms you signed.
The point isn't to be heavy-handed. It's to keep things fair and consistent, so every doula knows exactly where they stand.
Loula also keeps a separate Fraud, Waste, and Abuse policy that applies to everyone in the network. By participating, you agree to follow it. Questions can go to [email protected].
Staying in good standing
A few things sit outside billing but keep you in good standing with Loula and the plans we work with. Your provider agreement covers these in full, so we'll just flag them here:
Keep your credentials current, and send updates within 30 days. That means your CPR certification, annual HIPAA training, and professional liability insurance. Send Loula any updated documents within 30 days of receiving them. You can't bill while any of these are out of date, and claims denied because of expired credentials won't be paid.
Tell us promptly if your status changes. If there's a change to your license, insurance, Medi-Cal enrollment, or credentials, or if you face a legal action that could affect your work, let us know. Your agreement sets the specific timelines.
When in doubt, your signed provider agreement is the source of truth. This guide is the plain-language companion to it.
Speaking up about a concern
If you spot a billing mistake, your own or someone else's, or you're worried something isn't right, tell us. You can email [email protected], and you can do it anonymously if you'd prefer. We don't tolerate retaliation against anyone who raises a concern in good faith. And if you catch your own error and flag it before we or a health plan find it, we take that into account. Owning a mistake early always counts in your favor.
Acknowledgment
By working with the Loula network, you're confirming that you've read these policies and you're on board with following them. If anything here raises a question, reach out before providing or billing for services. We're always glad to help.
Questions about compliance or something that doesn't feel right:
[email protected]
Questions about billing or submitting visits:
[email protected]