After a traumatic week of labor with their first child that ended in a cesarean section, Eleanor Grano and her husband were burned out.
They got home from the hospital after the major abdominal surgery with their newborn son, and, with the help of family, paid about $2,400 for a doula to care for their baby overnight for nearly a week. This allowed Grano and her husband E.J. Fagan to rest and recover. Their parents and siblings don’t live nearby.
Grano and Fagan say their experience was transformative. Having a doula watch over their baby boy as they slept brought Grano relief and gave her time to care for herself. They call him Cinco: He’s the fifth Edward in the family.
Then, the doula’s time was up. Grano struggled with postpartum anxiety and grew exhausted from the around-the-clock care. She feared Cinco would die in his sleep.
“It was just this forever, all-consuming experience for me that … after I’ve gone through three years of infertility, miscarriage, like, all the battle wounds of infertility, that I was somehow still at risk of losing my child,” Grano recalls of her first baby, born two years ago.
So, as she and Fagan, who live in Riverside, thought about having another baby, they planned the pregnancy around a new Illinois law. It is intended to cover roughly a month of doula visits, capped at $8,000. Grano called it a lifeboat.
In 2024, Gov. JB Pritzker signed the Birth Equity Initiative to help prevent more women from dying, especially women of color. One key part of the law is broadening access to doulas.
Doulas are trained professionals who support families. They advocate on behalf of women in the delivery room and help manage pain or take care of newborns in the first weeks of their lives.
People with private insurance, like Grano and Fagan, could have a doula with no cost-sharing. The message to families: You won’t have to pay.
“Illinois has been the wild West of insurance companies,” state Rep. Robyn Gabel, D-Evanston, a lead sponsor of the legislation, said at a news conference the day Pritzker signed the law. “They have pretty much done whatever they wanted, and, in this administration, that is not going to be true any longer.”
Standing nearby was Lt. Gov. Juliana Stratton, who led the push for the law, which was part of a broader plan to invest in birth centers to diapers, an expense that can drain a family budget. She’s called it a national blueprint for saving the lives of pregnant women. It’s part of her campaign for the U.S. Senate this fall.
But passing a law is one thing. Implementing it is another.
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.
And only an estimated 30% of people with private insurance in Illinois have plans the state can regulate. For everyone else, it could be much harder to access this benefit.
Grano is due to give birth this week to a baby girl. She has spent nearly her entire pregnancy fighting her insurer, Blue Cross and Blue Shield of Illinois, the dominant insurer in the state, to cover her postpartum doula. Hours of messaging with Blue Cross representatives. Lots of stress during her high-risk pregnancy. Grano says the insurer wanted her to cover the cost — around $10,000 — and then seek reimbursement later, a huge financial risk.
In another case, a Chicago couple who had their baby girl about five months ago, is still trying to get Blue Cross to fully reimburse them for their overnight doula. And the insurer is trying to claw back nearly $2,000 it already paid, according to records the family shared with WBEZ and the Sun-Times.
The roadblocks to families when they need support the most, for a benefit they’re legally entitled to, are happening across the region. In many cases, doula agencies say women stop trying to use insurance to pay for support because it’s so much work.
“The families that we know are often limited on resources are the ones that really need the doula support, and they’re not getting it,” says Anna Rodney, who owns Chicago Family Doulas, a large organization that works with more than 500 doulas.
Presented with the WBEZ / Sun-Times findings, Gabel says she plans to advance a bill that would fix a major shortcoming with the law.
“If a family is interested in having a doula, they should be able to have one,” she says.
Trying to prevent a crisis
Doulas are becoming more mainstream as doctors and governments try to address an alarming inequity.
In Illinois, Black women are three times as likely to die from a pregnancy-related medical condition compared to white women. One in three women dies more than 60 days after giving birth, regardless of race.
Research shows having a doula is linked to better health outcomes for mothers and babies, including fewer premature births and lower C-section rates.
Pritzker started doula coverage for families with low incomes or disabilities in the state’s Medicaid health insurance program about two years ago, joining nearly 30 other states.
With private insurance, Grano knew she’d have to wait longer. But she remembers thinking: This is what I need to get ahead of the anxiety that consumed me after my first baby was born.
When January rolled around, and the doula benefit began, Grano contacted Blue Cross to confirm she was eligible. She wasn’t even pregnant yet.
She says a customer-service agent told her the benefit wasn’t available. Grano contacted her two state representatives and told them what was happening.
They intervened immediately, and she learned that her benefit would start when her health insurance plan renewed July 1.
Relieved, she underwent an embryo transfer and became pregnant with a girl.
“I’m not going to have to feel like I’m in a crisis for the second pregnancy,” Grano remembers thinking.
In May, Blue Cross’ then-chief medical officer put out a news release that said covering doulas, among other providers, “strengthens the network of care around moms, babies and families and reflects our long-term commitment to maternal and infant health in Illinois.”
Come July, Blue Cross told Grano she could have 32 doula visits. She tried to book her postpartum doula for October when she’d be due for another C-section. She hit a wall.
Blue Cross told her 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.
Throughout months of messages with Blue Cross, Grano’s frustration grew. She told them she’s stressed and overwhelmed, how she has a high-risk pregnancy with chronic high blood pressure and a history of postpartum depression. She’s unemployed and juggling a toddler at home.
“I do not want to wait until I am postpartum and potentially struggling to figure out how to access this care,” she wrote in August to her Blue Cross’ well-being health adviser.
She pointed out that the law requires no cost-sharing for families.
“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.”
In a later exchange, the Blue Cross adviser apologized to Grano for how she’s feeling and said it’s good she’s communicating concerns.
“Congratulations and thank you for allowing me to be a part of this special time in your life!” the adviser wrote.
Fed up with Blue Cross, Grano filed a complaint with the Illinois Department of Insurance.
Fagan, Grano’s husband, called what Blue Cross is doin