Insurers could revisit denied doula coverage claims after Oregon agency admits error

Oregonians who were denied coverage for doula services since the beginning of this year could see their claims readjusted after state regulators informed health insurance providers that they misinterpreted Oregon laws mandating they take care of the cost of those services.

During “informal conversations” earlier this year with health benefit plan providers, state regulators provided incorrect information to insurers that a new Oregon law would push back earlier coverage requirements to reimburse the cost of doula services until 2028, according to an October memo from the Department of Consumer and Business Services’ Division of Financial Regulation.

But while the 2026 law delayed coverage of certain lactation services by 2028, a 2025 law from last year continues to mandate coverage of doula services for pregnant women for costs up to at least $3,760 each year, adjusted for inflation annually, according to the agency. That 2025 law ensures plans which cover pregnancy and childbirth also cover those doula services.

“DCBS expects health benefit plan issuers to reimburse doulas for services provided after January 1, 2026, consistent with the limits described above,” Oregon Insurance Commissioner TK Keen wrote in the memo. “Issuers should review any claims that were denied based on an understanding that SB 1568 had fully repealed the requirement to cover doula services during calendar year 2026.”

Sen. Lisa Reynolds, a Democrat from Portland who works as a pediatrician, introduced the doula laws as advocates for medical care in Oregon seek to build on the state’s access to prenatal services. Doulas often serve as evidence-based physical, emotional and informational guides for women during pregnancy rather than medical professionals.

But the consumer and business services agency attributed the error to its “understanding of the legislative intent as communicated by legislators and advocates.” Reynolds told the Capital Chronicle that there was an error and that “this is very complicated stuff.” She noted that she met with the agency over the summer and that they clarified her 2026 law was not “accurate enough” to delay reimbursement for doula services until 2028.

“Of course, I prefer the 1/1/2026 effective date as it connects more Oregonians to doula services – those on private insurance will receive the supports already enjoyed by Oregonians on Medicaid,” she wrote in an email. “Doulas improve birth outcomes and provide eyes and ears on patients in the postpartum period, which is still a time of tremendous vulnerability.”

Now, state regulators say they will give time to health insurance plans they regulate to reprocess those claims without worry of enforcement actions until enough time has passed to review denied claims and adjust their practices. The agency does not plan to refer complaints about a failure to adhere to the doula law to its enforcement or compliance staff until the beginning of next year.  

The potential for revisited claims won’t apply to all Oregonians with insurance. State regulators are able to regulate plans such as the state’s Oregon Health Plan for low-income Oregonians or commercial private health insurance plans which are based in the state. Their authority to enforce state laws does not apply to employer-sponsored “self-insured” or “self-funded” plans, which are restricted by federal insurance and employment law.