I just finished reading this article from the NY Times about how people who have had caesareans face more hurdles when they try to get individual health insurance. The article focuses on individual health insurance in Colorado, which made it especially interesting for me. Golden Rule – one of the companies mentioned in the article for declining applicants who have had caesareans – is one of our health insurance carriers. Over the years, we’ve had various underwriting outcomes from the companies we work with, ranging from declination of coverage, a higher deductible in the event of a future caesarean, or in some cases, a standard policy offer. In Colorado, health insurance companies have to cover complications of pregnancy, regardless of whether they cover routine pregnancy and delivery (the vast majority of individual health insurance carriers in Colorado do not) For a woman who has had a prior c-section, the chances of complications – and a future caesarean birth – are higher, and I can understand why health insurance companies would want to avoid that risk.
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. Consider this case, where a woman has been awarded over $20 million because her baby was stuck in the birth canal for 13 hours before being delivered by caesarean. The assumption being that if the caesarean had been performed earlier, the little girl would not have the vision problems and mild retardation that she currently does. While it’s heartbreaking any time a baby is injured during pregnancy or birth, nobody needs $20 million to compensate for it. In a case where docs are found negligent during a birth, the amount of the financial award should be limited to roughly what will be needed to care for the injured party. People should not be profiting financially from tragic medical situations. But they are, and I’m sure that stories like this scare a lot of doctors into performing caesareans at the first sign of a hitch during labor. It’s a sad system that we have.
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.