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

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32 thoughts on “Loss of insurance – another price to pay after a c-section?

  1. Makes me glad to be Canadian. At first glance it almost looks like hey the insurance companies want to help reduce the number of c-sections, however that is really giving them much more credit.

  2. Seems that if doctors and nurses did more to help along labor, the rate could be decreased. When I gave birth my labor slowed so much they kept saying ‘c-section’ if I didn’t progress. Yet they did nothing to help me progress. I had to keep calling the nurses (which waited forever to come in!) to un-wrap me from all the nonsense so I could get up and walk around. I was literally minutes from a c-section but I was so upset about it the doc gave me another hour to progress, and thankfully I did – hubby and I praying the whole time!

    So many women I know have had c-sections for the same reason. It was taking to long. Some were asked if they wanted to keep laboring or just get it over with, and without any support (and the doctors saying it’ll be easier) they went along with it just to get labor over and done with.

    My next one (Lord willing soon) I’d like to have a midwife. I’ve found a few that actually work through an OB’s office so insurance stuff will be easier as well as the fact that I can birth in the hospital. (home birth is not my thing:-) I think having the extra support will be beneficial, as the midwife would show up when I hit about 5 cm, instead of the nurses having me start pushing before the doctor is even leaving his house!

  3. Wow, thanks for sharing this info! but seriously are hte insurance co. have the right to do that! it dosn’t sound ecthical!

  4. I think it’s unfair to just put all c-sections in one category. I had a section because my son was folded in half with his heiney in the canal and I had no fluid left. They tried to turn him for as long as they could, but he was stuck and sick.

    If we have another, I desperately want a VBAC (as I had a vaginal birth with my daughter) and will drive longer if I have to to find someone who will help me acheive that!

  5. Before commenting on the article I wanted to say to Stephanie above that Amy is not cateogorizing all C-sections into one category – she’s all for emergency C-sections and it certainly sounds like your situation demanded one.

    Amy, this was a very informative post that has made women caught. They go to the hospital to have their baby and they receive intervention from the medical staff which in turn complicates their labor and stresses the baby causing them to need the surgery. Then to find out they won’t be covered by their insurance is just awful.

    I wish I knew what private insurers cover maternity as mentioned in your article as well. My husband is self employed so we don’t get group coverage as most employees receive and I have not seen one policy that covers maternity. If I were to get pregnant again, all costs would be out of pocket. (I think I’d do what you did though and seek a midwife/home birth. Cheaper and safe enough!)

  6. Wow, that’s just…ick. Health insurance is such a disgusting scam. You pay and pay and pay every month, for them to not cover you when you need it most. Lame-tastic.

    p.s. I tagged you for a 6 quirks meme, if you’re interested…

  7. Great post, Amy! It’s so unfortunate this situation with the healthcare industry. I wrote a post on the increased rates of c-section: http://www.quiskaeya.com/2008/04/i-am-that-woman-that-statistic.html

    and my views about it. Coming from a personal experience I had both my children via c-section. I’ll have to be honest, at times I wonder if it was necessary. Most of the times I think it was.

    I can understand to a degree why ins companies are rejecting a woman who has had c-sections prior (NOT that I AGREE w/ it). But with the rates of c-sections on the rise and a good percent of them not warranted it somewhat puts ins companies in a precarious position. Another article I wrote a post about the increase rate in elective c-sections. I can’t understand why a woman would choose to have a c-section when it’s not medically necessary. In this situation, should an insurance company be forced to pay for it? It’s a hard question and I honestly don’t have a clear cut answer.

  8. Just terrible how insurance companies can treat people. I had a c-section with my last pregnancy (urgent and necessary), and I’d hate to be looking for insurance coverage now. I would certainly hope to be allowed VBAC rather than go through that again!

  9. While it’s not the best way to lower the c-section rate, taking the financial incentive away from hospitals might have a positive affect in the long run. Of course the best way to lower it is for women to educate themselves as to when a c-section is TRULY needed. Unfortunately, the majority of women (in my experience) still believe that in THEIR case a c-section was truly needed. Without knowing all the facts, I certainly can’t comment on someone else’s birth, but a “baby folded in half” is simply in a breech position. Despite what most doctors say, these babies can generally be born vaginally. Little or no fluid is not necessarily bad. Gail Dahl, author of the best-selling book “Pregnancy and Childbirth Secrets” writes, “Some babies are born with very little or no amniotic fluid. The body is able to compensate for this situation.” Our greatest enemy in birth is fear. When women start trusting their bodies and believing in their own abilities the c-section rate will plummet.

  10. I agree 100%! Have you seen the new movie out called The Business of Being Born? It’s WELL worth watching!
    I’m lucky to have known exactly what I wanted when my son was born. It wasn’t easy, but I didn’t let them push me into anything I didn’t want. (like Pitocin)
    So now I don’t have to worry about a c-section history and have recently gotten insurance. But something needs to be done when I’m paying $200 out of pocket every month just in case something happens to me? Crazy times.

  11. Great Post. Particularly liked Louise’s comment on how C-Sections should be covered only if medically necessary.

    This country has a too-high C-Section rate and nothing seems to be happening to bring it down. Nothing that would be beneficial to the mothers, that is. That’s not news, though.

  12. Thanks for mentioning my article. This is a topic that I feel deserves a lot more attention than it gets. We have a one-month-old who was born at home after 45 hours of labor. I was stuck at 9cm for about 8 hours, and I’m sure that had we been in the hospital there would have been lots of intervention to speed up the process, and they probably would have pushed for a c-section. Great post – thanks for getting this topic out there, and congrats on your home birth too!

  13. Things like this make me so angry. I had an urgent Caesarean with my first daughter after 21 hours of labor that included 2 hours of non-productive pushing. Had my (via my husband’s company) insurance denied payment, heads would have rolled. I am so tired of this misogynistic healthcare system.
    I was denied access to a VBAC with my second child because our crappy ass HMO (different than with my first) a- discouraged them and then b- the hospital my doctor/HMO contracted to disallowed them 2 months before my delivery. Thinking that I would have to pay out of pocket because it was technically elective make me seethe.
    Yes, the c-section rates has increased but so have the number of obstetric/ birth trauma malpractice suits. Doctors have more control in a surgical situation. They want to cover their asses.
    There has got to be a happy medium. Our babies deserve it.

  14. I’m so glad you wrote about this. Just last night I was literally throwing a tantrum (ask my DH) over our ridiculous insurance plan not covering a birthing center or CP midwife. I was in tears and there aren’t even words to describe how frustrated I am over this. I’m not pregnant now, but believe in planning ahead, and I was mistreated at my daughter’s hospital birth. My doctor decided to surprise me by coming up as soon as I was admitted to break my water, after I had JUST seen him in his office, where he never mentioned it. This led to an epidural, which nearly led to a c-section. I ended up with a painful episiotomy. I will not be having a hospital birth again, and we will probably have a big bill to pay for a non-covered birth-center. If insurance companies want to force mothers to birth in hospitals where many women are coerced into c-sections, they need to at least stand behind their decision by giving these women the regular-rate coverage they deserve! I hope things change soon, but I doubt it’ll happen before we have another baby. It’s nice to know there are so many people wanting this change.

  15. I get so frustrated with insurance companies that can write their own ticket and seemingly answering to no one. Granted I do not want the govt to take this over but something needs to change.

    I HAD to have a c-section NOT my first or last choice. I had complete placenta previa.

  16. First off — I find this disturbing because I had 2 c-sections. One emergency and the other was planned (but he was breach also anyway). Very disturbing. Now, if she had her tubes tied (or a hysterectomy), does that negate the “repeat op” clause in their insurance?

    An aside, on National Healthcare — my first was born in England under a NHS system and it sucked from the minute I found out I was pregnant until after I gave birth. I had maybe two positive experiences with it and I will NEVER do it again. Yes I agree something needs to be done about health care in this country, but no way do we need to go to NHS. We need to reform the way the crooks at the insurance company operate. In my opinion.

    And lastly — I also had Gestational Diabetes with my 2nd (who is now 3) and just earlier this year I was denied excess life insurance because I had GD and was on insulin — despite the fact I’m fine now with no diabetes. So I feel her pain (although not as deeply).

  17. Ugh. Stupid insurance companies.

    I’m torn about c-sections. I’m apparently the only woman in forever whose doctors were so opposed to c-sections that both my daughter and I nearly died during birth. I should’ve been scheduled for a c-section, I had placenta previa (became percreta – I nearly bled to death), with a high risk pregnancy and a family history of not going into labor naturally.

    But I also had doctors that didn’t believe in ‘unnecessary’ c-sections. Which, instead lead to them not doing a very necessary one.

    The real issues are that childbirth has become so institutionalized that women aren’t listened to by their doctors, and doctors and midwives aren’t listened to by the insurance companies. It’s just horrid.

  18. While it seems all well and good to say that insurance should not cover cesareans that aren’t medically necessary, and women need to learn how to judge better, and insurance companies shouldn’t charge more for women with a cesarean history…it just doesn’t work out well in “real life.”

    In real life Dr’s will commit insurance fraud to keep a client. That is, they will manufacture reasons to perform cesareans so that insurance coverage is guarunteed. They know that if they don’t do it, the next Dr. down the street will…so why not…sure, the baby is predicted to be too big for vaginal birth… I even had a dentist offer to try and come up with a reason to get my insurance to pay for general anesthesia for extraction of my wisdom teeth (which BTW, would have cost me a mere $65 beyond what my insurance would have covered for local anesthesia 14 years ago when I was young and poor and couldn’t come up with that $65). Since my wisdom teeth were not impacted, all my insurance–which was pretty darned good–would pay for was local. I went with the local, and it really was all that was needed. I felt no pain…even went out to dinner that night–LOL!

    In real life women just don’t “get” in their first pregnancy how important it is to choose the proper care giver–which really is the single most important thing a woman can do to ensure a low risk of cesaraen. I certainly didn’t “get” it–despite warning signs with the practice I was going to, I stuck with it. Luckily none of them were on call when I went into labor. But as a doula, I see more clients than not who aren’t so lucky. And when the OB is saying that the baby must come out or will be harmed…how can you expect the parent to make a decision other than surgery?

    As for the insurance companies charging more (or denying coverage)…their expenses for a woman with a previous cesarean are higher than for a woman with previous vaginal birth–and it’s not just if she births again. She’s likely to have other long term health impacts which can be costly. Would it be “right” to simply spread out the expenses to all women–including those who have birthed vaginally?

    What really needs to be done is to switch back to a system where routine health care is paid for out of pocket by the consumer, and insurance is only for those unexpected bills that carry high price tags–a trip to the ER for a broken bone, an emergent cesarean in labor, a cancer diagnosis. Routine physicals, Dr visits for the common cold, and yes, prenatal care…should be paid for out of pocket. It will only be when this is done that medical costs will finally get under control.

    Don’t believe me? My midwife recently asked me if I wanted to pay directly for some lab work she was ordering, or have it billed to my insurance. She immediately said “if you pay directly, the lab bills $60, if you have your insurance billed, they will bill $300.” So basically the bottom line was that the billing was MUCH higher when going through insurance, and I was to make my decision based on what would be less costly to me. Turned out that my co-insurance payments would be much higher than $60, so I chose to pay directly.

  19. While it seems all well and good to say that insurance should not cover cesareans that aren’t medically necessary, and women need to learn how to judge better, and insurance companies shouldn’t charge more for women with a cesarean history…it just doesn’t work out well in “real life.”

    In real life Dr’s will commit insurance fraud to keep a client. That is, they will manufacture reasons to perform cesareans so that insurance coverage is guarunteed. They know that if they don’t do it, the next Dr. down the street will…so why not…sure, the baby is predicted to be too big for vaginal birth… I even had a dentist offer to try and come up with a reason to get my insurance to pay for general anesthesia for extraction of my wisdom teeth (which BTW, would have cost me a mere $65 beyond what my insurance would have covered for local anesthesia 14 years ago when I was young and poor and couldn’t come up with that $65). Since my wisdom teeth were not impacted, all my insurance–which was pretty darned good–would pay for was local. I went with the local, and it really was all that was needed. I felt no pain…even went out to dinner that night–LOL!

    In real life women just don’t “get” in their first pregnancy how important it is to choose the proper care giver–which really is the single most important thing a woman can do to ensure a low risk of cesaraen. I certainly didn’t “get” it–despite warning signs with the practice I was going to, I stuck with it. Luckily none of them were on call when I went into labor. But as a doula, I see more clients than not who aren’t so lucky. And when the OB is saying that the baby must come out or will be harmed…how can you expect the parent to make a decision other than surgery?

    As for the insurance companies charging more (or denying coverage)…their expenses for a woman with a previous cesarean are higher than for a woman with previous vaginal birth–and it’s not just if she births again. She’s likely to have other long term health impacts which can be costly. Would it be “right” to simply spread out the expenses to all women–including those who have birthed vaginally?

    What really needs to be done is to switch back to a system where routine health care is paid for out of pocket by the consumer, and insurance is only for those unexpected bills that carry high price tags–a trip to the ER for a broken bone, an emergent cesarean in labor, a cancer diagnosis. Routine physicals, Dr visits for the common cold, and yes, prenatal care…should be paid for out of pocket. It will only be when this is done that medical costs will finally get under control.

    Don’t believe me? My midwife recently asked me if I wanted to pay directly for some lab work she was ordering, or have it billed to my insurance. She immediately said “if you pay directly, the lab bills $60, if you have your insurance billed, they will bill $300.” So basically the bottom line was that the billing was MUCH higher when going through insurance, and I was to make my decision based on what would be less costly to me. Turned out that my co-insurance payments would be much higher than $60, so I chose to pay directly.

  20. I read this post last week while we were waiting to hear if we would be approved for insurance (non-group).

    We were approved, but a rider was put on me for c-sections for 3 years. I sort of laughed, because we’re not having any more kiddos, so I definitely won’t be having any more c-sections.

    But I’m glad I knew about this beforehand. Thanks for sharing.

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  25. Thank you for choosing to be a home birth midwife and providing an alternative for all of us who would rather not be cut and poked and prodded during the birth of our children. I suppose it’s easier and more timely for them to do c-sections as a routine practice. We plan to have our children at home, and I’d have to be in a pretty dire situation in order to want to give birth in a hospital.

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  27. to Jenn, the part of your post that mentioned paying directly for lab costs instead of filing through your insurance goes against policy, it’s essentially insurance fraud by you and your physician’s office. You can’t be both self pay and insured.
    i have had 2 c-sections both necessary because my babies will not fit into my birth canal (mother had c-sections as well). I’m having trouble getting coverage right now b/c of these previous c-sections which is ridiculous. It’s a life for God sake; a future customer at that!!!!

  28. Thanks for the information, I’ve been researching c sections for our blog. I find this ludicrous, luckily we dont have health insurance in the UK.

  29. This is a topic that I feel deserves a lot more attention than it gets. We have a one-month-old who was born at home after 45 hours of labor. I was stuck at 9cm for about 8 hours, and I’m sure that had we been in the hospital there would have been lots of intervention to speed up the process, and they probably would have pushed for a c-section.

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