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Tuesday
Jun032008

Cesarean Punishment

Insurance companies have begun refusing coverage to post-cesarean moms unless they have been sterilized during their cesarean.

The International Cesarean Awareness Network - ICAN - reports:

"Peggy Robertson of Colorado. When she applied for health insurance coverage with Golden Rule, her husband and her children were accepted, but her application was denied. After multiple inquiries directed to the insurance company, she was finally told that she was denied because she had delivered one of her children by cesarean. 'It was shocking. I assumed that as a woman in good health I would be readily accepted,' said Robertson. 'When I finally found someone who would explain why my application was denied, they had the audacity to ask me if I had been sterilized, stating that this was the only way I could get insurance coverage with them.'"

The New York Times article says:

"She was turned down because she had given birth by caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."

Also, "Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.

'Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,' Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

'“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,' Ms. Pisano said."

As an FYI, Golden Rule insurance company is owned by United Healthcare.

"Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized."

While I hadn't heard of this, it doesn't completely surprise me. I am individually un-insurable because of the gastric bypass. I used to be un-insurable because of diabetes and morbid obesity. Even though the gastric bypass put both diabetes and obesity to in the background, the fact of the surgery alone is cause enough to never be able to buy my own insurance.

I seriously wonder what will happen to the cesarean rate if ALL women had to pay for the surgery out of their own pockets. Scheduling a cesarean will come with a whole new set of issues besides the uterine scar, the secondary infertility, the placental difficulties, the higher risk of dying and having a premature baby as well as post-op pain and a much longer recovery. I wonder if finances will have any impact at all.

A part of me applauds the possible ramifications of their discrimination. Not the actual denials, but the possibilities it affords women who've had cesareans previously. Will VBAC once again be the preferred subsequent delivery?

This is certainly an interesting (and sad) development; we will all have to watch unfold.

Reader Comments (11)

Now if only the insurance companies would see the cost-effectiveness of home birth.

June 3, 2008 | Unregistered CommenterKaren

wow. Your insurance companies scare me. I'm a home birth advocate but I believe in the neccessity of saving the mama.
p.s. I looove that photo of the woman in the pool. I've been reading through a feed reader and I'm glad I clicked through because I would have missed it otherwise.

June 3, 2008 | Unregistered CommenterLala

Funny. Doesn't Golden Rule mean "Do onto others as you would wish them do onto you"?

It seems we are increasingly in a bind here by the same industry that brought us skyrocketing malpractice insurance, defensive obstetrics, and arguably, the cesarean epidemic itself. Enough to turn this woman into a single payer universal healthcare communist.

June 3, 2008 | Unregistered CommenterJudit

Yeah, that's what I thought. Golden Rule my @ss.

What about a mother who has placenta previa or a breech for her first birth? As many C-sections that we have that are unnecessary, there ARE some that save lives, obviously. It isn't like the mother had control over where her placenta implanted or whether or not her baby was breech. So mom should be punished?

And really, I don't fault women for unnecessary C-sections as only 2% of them are completely elective; when a doctor tells a woman her baby is in danger whether it is true or not, mom is going to listen to the doctor and err on the side of caution. So again, should she be punished?

This was bound to happen with the backlash against VBACs and increase in first-time Cesareans.

I don't think this will give the docs the incentive to do ANYTHING differently, it will just punish mothers and babies. And that is completely unfair.

Chris

June 3, 2008 | Unregistered CommenterAnonymous

Don't even get me started on this topic...I'm so bitter about it all, trying to GIP has become a real challenge. Add to that the my insurance company WILL pay for a repeat c/s but NOT a homebirth, I'm sure you can imagine my frustration.

June 4, 2008 | Unregistered CommenterI am a Monkey's Mama

The REALLY sad thing is that there is an easy, cost effective way to fix this: Single price coverage.

You get X amount if you provide prenatal and baby catching services for a woman. Takes away the financial incentive to slice women hip to hip, saves the insurance company money, AND gives midwives more for their excellent care of women. Why should the OB that shows up for 5 minutes of an appointment and 10 minutes of the baby catching make so much more than the midwife, who takes all that time to actually HELP a woman, as she likes, to give birth!

Okay, so who left this soapbox sitting here right in front of me...

June 4, 2008 | Unregistered CommenterHomebody

Sounds like we're going to have a war between medical and malpractice insurance on our hands. A big reason given for the rise in c/s rates and VBAC bans in hospitals and OB practices around the country is that the malpractice insurance doctors carry is mandating when a c/s should be done... Stuck between a rock and a hard place? It all boils down to the $$$.

June 5, 2008 | Unregistered CommenterKEM

Yep -- insurance companies have to make a profit in order to survive. With the birth climate the way it is, and repeat C-sections the only way most women are *allowed* to birth after a primary C, it can get expensive. I don't know how much C/s cost everywhere, but my friend was billed $25,000 for her uncomplicated C-section due to transverse lie at SROM (just the hospital part, not the doctor's charges), and she didn't even stay in the hospital a full 48 hours. She had to pay 20%, which means that the insurance company had to pay about $20,000 (assuming they didn't have some sort of maximum pay-out for services). If she were to go on to have 2 more children both by C-section, you're looking at $40,000 more. Let's say she has all 3 children within 10 years -- that's $500 per month, just to recoup the cost to the insurance copmany of the C-sections, and doesn't count any other doctors' visits for the pregnancies or any other issues a woman might have over the course of 10 years.

It's time for insurance companies to stop paying for elective C-sections, just as they don't pay for other elective surgeries like cosmetic surgery. The problem, though, is that you may get docs hesitant to perform a truly necessary C-section, lest the insurance company deny the claim. Sigh...

Promote home birth, and the problem is greatly reduced!!!

-Kathy

June 5, 2008 | Unregistered Commenterwomantowomancbe

I guess I am lucky; it looks as though my state medical coverage IS in fact going to pay for what would be considered an 'elective' c-section. Yes; I am one of the 3% of women who are choosing to undergo surgery as a means of giving birth, and I was quite surprised (greatfull) when the office I sought out told me that it would appear to 'not be a problem' with my insurance. While I might not have a 'medical reason' in the sense of my physical body I have to beg the question of what exactly qualifies as a 'medical reason'? What about women who were sexually traumatized as children (or even as adults or teens); women who suffer tokophobia (especially due to abuse)... -should these women be denied the right to motherhood should c-section be their only realistic birthing option (as is in my case)? -They didn't 'elect' to be abused/raped/torchered so why should they be further punished for what someone else did to them? -I am full aware of counceling and birthing classes/services provided but I don't think all people are magically going to conquor their life-long fears in 9 months of therapy or classes (which total cost might just make the same difference as the c-section to birth cost difference anyway). All I can see happening by denying coverage or taking it away due to c-section are law suits and lots of them! -I don't see how anyone can compare a c-section to cosmetic surgery; that's ridiculous! I am sure there is trully only a tiny fraction of the 3% of 'electives' that would qualify as being done for vanity reasons alone; we are talking about human lives here not rinoplasty! I don't think insurance companies should be so worried about the one or two c-sections a woman might have. I do think if you can afford to have more than one or two children than perhaps you can also afford to pay a little more when it comes to babys 3,4, and so on but it seems wrong to cut off coverage without prior warning. All of this energy should be invested in catching the people commiting insurance fraud for major dollars rather than chastising women for their birthing choices; And yes insurance should cover home birth as an option as well.
Hot topic :)
-J.

June 20, 2008 | Unregistered CommenterAnonymous

As a repeat c-section person myself, that's scary. My husband several times has almost left his company for a small one where we would be getting private insurance. I am pregnant with my fifth and am not a candidate for VBAC. My uterus is abnormal and prevents the babies from turning or being delivered vaginally. I WANT a homebirth- always did. But it's just not possible for me. And since it's against my religious beliefs to be sterilized then they are in violation of my freedom of religion and discriminating me based on my religious beliefs. Think I can sue? heh springolife@trostfamily.org

July 2, 2008 | Unregistered Commenterspringolife

If a c-section is medially necessary how can an insurance company refuse it? I certainly encourage VBAC's but depending on the woman they can be risky.

February 8, 2010 | Unregistered Commenterc-section recovery

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