Some women who have had Caesarean sections have difficulty obtaining private health coverage

Jun 2 2008

Some insurers are denying individual coverage to women who have given birth via caesarean section because they are likely to undergo the procedure again, the New York Times reports. According to the Times, a c-section on average costs about $2,700 more than a vaginal birth.

According to the Times, it is unknown how many women have been denied individual coverage because of a prior c-section. The Times reports that the number is "likely to increase" because the number of people seeking individual health insurance has been steadily growing. Meanwhile, the proportion of births by c-section is at a record-high 31.1%, with more than 1.2 million performed in the U.S. in 2006. According to researchers, about 500,000 women annually who undergo c-sections have previously had the procedure. According to the Times, women who have had a c-section can safely deliver vaginally later, but many physicians have begun requiring women to have c-sections because of a small risk of uterine rupture, a potentially fatal complication.

Pamela Udy, president of the International Caesarean Awareness Network, said, "Obstetricians are rendering large numbers of women uninsurable by overusing this surgery." She added that women feel pressure to have c-sections that they might not want or need and then be denied coverage for the surgery.

According to Susan Pisano of America's Health Insurance Plans, insurers' rules on c-sections vary by company and state, depending on state regulations. Pisano added that some insurers do not factor a prior c-section into coverage decisions, while other insurers consider it a pre-existing condition. Some insurers include a rider that states coverage for a c-section is excluded for a certain period of time, according to Pisano. Pisano added that insurers who do accept women who have had the procedure typically charge higher premiums.

According to the Times, "to people familiar with the rough and tumble world of individual insurance, the companies' practices are no surprise." Insurers "say they need these strategies to protect themselves, because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses," according to the Times. In addition, the Times reports that insurers "often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience -- to deliver the baby at a certain time or to avoid labor."

The article profiles Peggy Robertson, a 39-year-old woman who was denied coverage by the Golden Rule Insurance Company, owned by UnitedHealthcare, because of a prior c-section (Grady, New York Times, 6/1).