Insurers Denying Coverage to Women Who’ve Had C-sections

If you have read my blog for a while, you know that I write frequently about c-sections.  It is my opinion that Cesarean sections are over performed in this country.  Previous posts I have written, discuss many of the complications that can arise from c-sections.  Despite the many risks and complications associated with c-sections, the c-section rate continues to rise.  Last year in the US, it was 31.1 percent of births.  That is a little more than one in three births.

The New York Times had an article on Sunday reporting that many insurance companies will no longer accept mothers who have had a previous c-section.  The thinking behind this is, once a woman has had one c-section chances are, she will have another one.  Because VBAC’s (vaginal birth after cesarean) are banned and prohibited in so many hospitals, the only choice basically left for women birthing another baby after a c-section, is another c-section.  Because so many c-sections are not medically necessary, the insurance companies don’t want to pay for them. 

Insurance companies are rejecting these mothers coverage, and some insurers even consider having a c-section, a pre-existing condition.  What makes this even scarier, is once someone has been denied coverage and rejected by one insurance company, they have to disclose that to subsequent insurance companies they apply to.  Once an insurance company sees the mother has been rejected, a red flag goes up, and makes it even harder to get coverage.  If they do get coverage their premiums are extremely pricey and expensive.  In Colorado it was estimated some premiums would be 140% more than standard rates. 

The article quoted Pamela Udy, from the nonprofit group, International Caesarean Awareness Network, (ICAN) whose mission is to prevent unnecessary Cesareans.  ”Obstetricians are rendering large numbers of women uninsurable by overusing this surgery.”

There are a few “exceptions” some of the insurance companies are making, where they will cover a woman who has had a previous c-section, such as:  

  • If the woman has been sterilized after the cesarean section
  • If the woman is over the age of 40 AND at least two years had past since the c-section
  • If after five years, there has not been a complicated pregnancy AND another c-section

These hardly seem like fair options.  You can only get coverage after a c-section if you have been sterilized? 

This is definitely a fall out from c-sections being performed unnecessarily.  The article mentions that women are caught in the middle of this mess between insurance companies and doctors. Pamela Udy says,  “Women are caught in the middle of a dysfunctional system. Doctors are telling them they need surgery, even when they don’t, and insurance companies, who are tired of paying the bill for so many frivolous surgeries, are punishing women for the poor medical care of doctors.”

This situation should be alarming for every woman 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 VBAC’s, 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. 

Comments

  1. As a mother who has had FOUR c-sections and the daughter of a litigator, this is a hot button topic with me and I’m glad you covered it. Malpractice insurance rates are one of the biggest contributors to the dramatic rise in c-sections…the insurance companies themselves bear an awful lot of the onus in this situation as they helped create it.

    Thankfully, I have had WONDERFUL sections and never had any post-op complications and have always healed relatively quickly. Yes I would have liked to have given birth naturally. But unfortunately, my body never worked that way.

  2. donna says:

    I agree with the doctors abusing their power and am sickened that the ins. companies have taken such a disgusting turn.

    As some one who once studied to become a Doula and Child Birth educater and a skeptic and cynic when it comes to insuranc – any insurance – this post covers both topics well.

  3. Nature Deva says:

    I read this article in the paper yesterday and was so mad that they are doing this to women.

    I just found out my SIL who is 36 can’t stop bleeding from her last (4th) c-section in March and has been advised to have a total hysterectomy now. My other SIL had 3 c-sections, a back problem and ended up having a hysterectomy, too.

    It all freaks me out – having had one c-section and a very hard recovery with back problems and if I need to ever get new insurance I could be denied coverage just from that? It’s just wrong!

  4. DCochran says:

    Thanks for bringing light to this. I had an emergency c-section with my first pregancy due to premature labor in my 24th week. We lost our son a month later. With my second I was high risk and another was performed prior to my due date. I was then told I could not be insured for up to 18 months. When there are curcumstances beyond your control, and this is not an elected proceedure, it is unfair that the insurance companies deny the indvidual.

  5. A Mama's Blog says:

    DCochran- I am so sorry for the loss of your son. I can’t even imagine the pain associated with losing a baby.

    Your case is so unfair, and illustrates this problem to a T. You needed an emergency c-section, but because c-sections are done so often now, for non-emergency deliveries, you are being penalized now, and can’t get coverage.

    This is SO wrong on all levels. Again, I am so sorry, and wish you all the best. Thanks for sharing your story.

  6. Cassie says:

    Good to know! I hope I don’t have to have an emergency C-section as it is, but this is just ridiculous. How is having a C-section a “pre-existing condition?” I agree that doctors are overusing C-sections, mine told me that I would have to have one when he thought the baby would be breech. Luckily he turned head down a week later, but still.

  7. Hard to believe!! Ugh.

  8. Kim Priestap says:

    Well, it’s a good thing insurance companies didn’t take this tack when I was pregnant. I had three c-sections because they were medically necessary. I can’t deliver babies vaginally because of a protruded sacrum. The only way my babies come out is by c-section.

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