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

June 2, 2008

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!

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