Had a C-Section? You Could Pay More for Health Insurance, Be Denied Coverage

By Rachel Walden |

Yesterday’s New York Times includes an article profiling Peggy Robertson, a woman seeking individual insurance coverage who was denied by the Golden Rule Insurance Company because of a past cesarean section.

Federal HIPAA law prohibits exclusion based on pregnancy as a pre-existing condition, but this aspect of the law is focused on group health plans rather than individual coverage. The piece reports that another insurer, Blue Cross Blue Shield of Florida, “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.”

I find this extremely troubling, because it appears that some insurers are using this tactic to simply deny coverage to pregnant women. Women with a past cesarean may have future vaginal births (if a covered facility permits them) or have no further children (without having been sterilized), so insurers who deny coverage based on a past cesarean are essentially excluding all women with past c-sections who might ever become pregnant.

In fact, the Times reports that Robertson received, “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.” In other words, if it were unlikely that she could or planned to have more children, she would have been eligible, regardless of how those children might have eventually been born.

Perhaps these companies should charge more of men who might get a woman pregnant who might need a c-section, because it might one day cost them something for these men to successfully reproduce! Don’t forget denying coverage to the resulting children – they might get sick one day!

5 Comments

  1. And what about the skyrocketing rate of c-sections, most at urging of doctors, many of whom do so because of malpractice concerns. Wouldn’t it be a whole lot healthier and cheaper to cut the c-section rate instead of dream up another way to victimize moms??

  2. Jacqueline says:

    Wow, since so many women report feeling pushed into having a c-section, this seems like some sort of punishment (I speak from personal experience here). On the flip-side, if more group plans go in this direction, maybe it will cause a rethinking of birth culture/ high c-section rates in the U.S.

  3. Melgirl says:

    IMO, the “bad guy” isn’t the insurance companies. We wouldn’t even be having this conversation if it weren’t for the gross overuse of cesarean by OBs. Cesareans are more lucrative for docs, “protect” them from lawsuits, and make it easier for them to get home by dinnertime. Insurance companies are just sick of financing the frivolous use surgery by docs. It’s royally offensive that insurance companies would punish women instead of the docs.

  4. Elizabeth says:

    I can see it from the insurance companies point of view — as a group, women are more expensive than men. Women who have had one c-section are more likely to have another. The company is just averaging it out. Doesn’t mean this is how it should work, but they’re just doing the logical thing.

  5. Hilary says:

    Yeah, I saw this, and I thought it was alarming.

    The blame for the rising cesarean rate can be passed around, it doesn’t just fall on the shoulders of OBs. And, regardless of the rising cesarean rate, the rabid desire of insurance companies to deny coverage, especially for maternity does earn them a place on the bad guys list.

    Why am I not surprised at all the insurance company involved is BCBSF? They refused to allow me to add maternity coverage unless I proved I was not pregnant. I had to take a negative pregnancy test and wait a certain period of time to start paying extra for the extra services they consider maternity coverage to fall under. 50% of pregnancies in the United States are unplanned, as mine was.

    Also problematic is the fact that almost half of women in Miami area hospitals are receiving cesareans. Is it because Miami also ranks as the worst city for obstetrical malpractice cases? Bad guy list gets longer.

    I think the ACOG statement recommending that a obstetrician be on hand for all VBACs was also a major culprit for increasing cesarean rates. Not only is there higher risk for cesarean deliveries, but it goes up with each subsequent delivery. This may explain some of the problem that insurance companies have, but when it affects SO many women, I don’t see how they can ethically use previous cesarean as a restrictive tool in giving insurance.

    Finally, I do see a silver lining in this. As much as childbirth connection may argue with me, some of the shift has at least been done with the cooperation of some mothers. The elderly Ob/gyn who is the faculty advisor for our Ob/gyn interest group says he used to be able to threaten women with increased cesarean risk to get them to modify their behavior. He says that it doesn’t work anymore. Women aren’t afraid of it.

    Maybe this news will change attitudes a little bit. Doctors need to be paid by insurance, and women need to be covered. Hopefully in the ensuing commotion about this story, some people stop and wonder if decreasing cesareans may be a good idea.

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