Does a caesarean = no insurance?

Filed under: Just For Moms, Your Pregnancy, Health & Safety: Babies, Medical Conditions, In The News

For some women, it does. As the number of individuals seeking their own health insurance (not through an employer-sponsored plan) increases right along with the startling number of women getting C-sections these days, insurance companies are making it harder for such women to be covered in the same manner as everyone else.

A recent New York Times article explores--and somehow, expresses some incredulity, or maybe that's just mine--the phenomenon, which is leaving some women with few options. The problem isn't necessarily the first Caesarean; it;s any others that might follow it. As you may know, it is unlikely a woman will be offered the opportunity for a natural birth, also known as a VBAC (Vaginal Birth After Caesarean) after having a C-section.

People like to talk--some of them in this article, for example, do--about how much of a possibility it is to have a VBAC after a C-section, and, well, it just ain't so. At least not anywhere I've read or among any of the women I've known. Perhaps the number of VBACs is growing these days but there was a time when it was unthinkable to do such a thing, mainly for fear of uterine rupture.

Insurance companies know the true cost of a C-section. (For those of you who've had one and have seen the bill or Explanation of Medical Benefits, I am sure you were shocked to see the numbers too!) And those insurance companies do not want to pay for another C-section, the first occurrence of which they are referring to as a pre-existing condition. Hence, they're outright denying women coverage or making it very, very expensive to get it.

Or, in some cases, they attach riders--you can't have a C-section within a certain amount of time, or you have to be over a certain age, or you have to have already had your two kids. I'm sorry, but to me this sounds like good old sexism. I can assure you, regardless of the cost, if this were a male issue it would be addressed immediately.

Although some women elect Caesareans, many women find themselves without a choice. Now, all these women face an even tougher challenge if they need to get insurance on their own. Fewer employers are electing to offer medical coverage and those who work for themselves must get their own plans or pay for things out of pocket. It makes the thought of pregnancy and birth daunting, and for some, probably unfeasible. How terrible, to think twice about whether or not you want to have a baby because of fear your insurance won't cover you!

I'd love to know if any of you have had such an experience. Did you have a C-section out of necessity (not by choice)? Were you offered the option of a VBAC the second time around? Have any of you had issues with insurance coverage as a result of your C-section?

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AdviceMama Says:
Start by teaching him that it is safe to do so.