Loss of insurance – another price to pay after a c-section?

An article in the New York Times this weekend reported that some women are being forced to pay higher health insurance premiums or are being denied insurance coverage all together if they’ve had a Caesarean section in their past. Peggy Robertson of Centennial, Colo., was turned down for individual health coverage by Golden Rule Insurance Company because she had given birth by c-section. No matter that she was in perfect health. “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.”

Photo courtesy grendellion
Photo courtesy grendellion

This could be a serious problem and affect countless women given the c-section rate in this country. It is believed that the current c-section rate in the United States is at a record high of more than 30% (that is nearly 1 in 3 babies is born via cesarean section) despite the World Health Organization’s recommendation that says “the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).”

Tina Cassidy from The Birth Book Blog believes the situation with the insurance company all comes down to money.

As always, it is money dictating the rules of health care. Of course, money (malpractice fears) is one of the reasons why the c-section rate in the US at 1 out of every 3 births. Honestly, it is surprising that it took insurance companies this long to wake up to the fact that they are paying either way — for the c-sections that don’t get done when they should, those that get done poorly (regardless of whether they were necessary) or when a woman is denied access to a vaginal birth after cesarean, which is happening more and more…

Perhaps it does all come down to money, but if that really were the case, then why wouldn’t my insurance company reimburse me a measly $2000 (relatively speaking) to cover my prenatal care, home birth, and postnatal care that I had with a midwife for my son’s birth in 2006? They refused to pay me one single penny, yet had I given birth in a hospital, they would’ve covered the entire thing (tens of thousands of dollars since I would’ve had a c-section due to my son being a surprise breech) less my one-time $10 copay. Logically, I figured that they’d rather pay for the lesser of the two, but logic apparently has no place when dealing with insurance companies. Maybe Tina is right on with her assessment. After all, why would they want to reimburse me and pay $2000 when they can get away with paying nothing at all?

Sharon Holley at The Traveling Midwife feels this is a great example for why we need national health coverage and also pondered what this could mean for the future of midwives and had other questions as well.

If insurance companies are going to start denying coverage for previous cesarean sections then what is to stop them from denying coverage for any type of previous surgery? Will this help bring midwives more respect as we have better c-section rates and still maintain excellent outcomes nationwide? Currently midwives are always battling with insurance companies to reimburse for care. Even Medicare and Medicaid does not pay 100% for services when compared to same services that are provided by physicians. Will this push women to question the need for a cesarean at the time of delivery?

Heather at A Mama’s Blog who has had both a c-section and a VBAC (vaginal birth after cesarean) and has written about in the past about her c-section experience and what a c-section is really like believes the insurance situation should be alarming for all women in their child-bearing years.

Even if you have no intention what-so-ever of having a c-section, in the rare case that you did need a medically necessary one, you can be denied insurance coverage now, because the procedure has been over performed.

Doctors and hospitals must start allowing VBACs, and return to delivering breech babies, in order to lower the ever rising c-section rate. If nothing else, c-sections should be reserved for true emergency situations. Something has to change – now more than ever, our very health depends on it.

Louise at Colorado Health Insurance Insider writes about her experience in the insurance business and says:

I’ve written before about how caesareans should only be covered by health insurance if they are medically necessary – “elective” c-sections should always be patient-pay, regardless of what health insurance carrier the patient has. It mystifies me as to why someone would willingly choose a c-section instead of a vaginal birth, considering the increased risks, much longer recovery time, and permanent scar. But at the same time, a lot of doctors are also guilty of over-using medical intervention for convenience in obstetric care. Part of the problem is the ridiculous malpractice system we have in this country.

Louise goes on to add:

For women who are trying to secure individual health insurance policies, a prior c-section can be a headache. They should be able to find at least one company willing to offer coverage, but it may not be their first choice, and it may come with a higher price tag. Just one more reason why a c-section should be a last resort, and should never be performed without a medical reason.

Jennifer Block at Pushed Birth feels a policy like this is adding insult to injury.

The losers in all this, of course, are women and their families: going through unnecessary primary cesareans, then being discouraged or flat out denied normal, physiological birth for their next pregnancy, on top of that being denied health insurance because the repeat cesarean their providers are insisting upon would cost the insurer more money, and having babies at higher risk of being born too early, not to mention the risks of repeated major abdominal surgery for mom. And we call this maternity “care”?

Carolyn McConnell of Rock the Cradle – The Politics of Motherhood agrees and points out the results of a 2005 survey where one quarter of the women polled “reported feeling pressured by a medical professional to have a C-section.”

And then they pay for it, in a high rate of infection of the incision, extended recovery and pain in comparison to vaginal birth, risks of injury to the baby, greater difficulty initiating breastfeeding, and greater risks of breathing problems in the baby—and finally in a loss of insurance coverage.

So, what now? On one hand I think it’s good that insurance companies are finally realizing the cost they having to bear as a result of a c-section rate that is inexcusably high and perhaps this will encourage more women to become better informed about c-sections before they go to the hospital. Maybe this will also put some pressure on the OBs that are performing unnecessary c-sections. On the other hand, I don’t feel it’s fair to women to raise their premiums or deny them coverage based on something that many of them may have been pressured into in the first place. And in the case that it was a medically-necessary c-section, then what? Another thing that is disturbing to me in all of this is that many hospitals have banned VBACs, so even if a woman wants to have a vaginal birth after a c-section, her options are often very limited.

I don’t know what the answer is, but I do know something needs to change in this country and the c-section rate must be lowered. Women, and their babies, deserve better care than this.

What do you think?

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Cross-posted at BlogHer