Category Archives: Insurance, medical

Please share your stories of insurance discrimination!

I’m forwarding this from ICAN.  Please forward far and wide.  We have the government’s attention.  They are ready to hear our stories.  Let’s turn the frustration, anger, and pain into real change!

If you have have discriminated against due to your prior cesarean, our government needs to hear about it!

ICAN needs stories about discriminatory insurance practices based on a previous cesarean.  This can include but is not limited to demands for sterilization, restrictions on how soon you can have another pregnancy and be covered, higher premiums, restrictions on the total amount of benefits they will pay, excessively high deductibles for maternity care.  Even if all you have is your name, state, contact information (email is fine) and a description of the circumstances (with the name of the relevant insurance company(ies) if possible) we can use it.  If you have written documentation, that would be pure gold.  There is interest about this at the highest levels of the Federal Govt. and we will use this to open the discussion on other areas of discrimination (like VBAC bans, lack of transparency, etc)….so please, take a moment and get the information to ICAN.  You can email me at advocacy@ican-online.org or you can snail mail to ICAN of Ann Arbor, PO Box 48, Stockbridge, MI  49285.

Your story could make a difference that would improve the care available for millions of women and their babies.

Below is a press release illustrating ICAN’s latest efforts.

ICAN Mother Provides Testimony on Capitol Hill Discriminatory Insurance Practices Investigated by Senate HELP Committee

REDONDO BEACH, CA, October 15, 2009 – Gretchen Humphries, Advocacy Director for the International Cesarean Awareness Network accompanied Peggy Robertson of Centennial, Colorado to a Senate hearing in the Health, Education, Labor and Pensions (HELP) Committee. Ms. Robertson testified about her experiences with discriminatory insurance practices based on her history of cesarean.

Ms. Robertson was featured in a New York Times article in July 2008 after she was declined insurance due to her previous cesarean. She was informed by the insurance company that her application would be accepted if she agreed to be sterilized.

As of 2007, 31.8% of childbearing women in the United States had a cesarean delivery and the rate continues to increase each year. These increases are due, in part, to the growing number of women who are denied the opportunity to have a vaginal birth after cesarean (VBAC) through similarly discriminatory VBAC bans. “The prospect of rendering a third of women uninsurable is frightening and unconscionable,” said Desirre Andrews, President of ICAN. “Many of these women are being pressured or bullied into first-time and repeat cesareans, and to doubly inflict them by leaving them without health insurance is offensive.” Clearly this type of practice potentially affects a very large number of women now and in the future as the cesarean rate continues to climb and the vaginal birth after cesarean rate continues to decline.

The practice of denying a woman health insurance because of a prior cesarean also indicts the medical community. Many of the cesareans performed today are unnecessary or the by-product of an over-interventive labor management process that is rooted in defensive medicine practices. “It is absolutely wrong to deny coverage to women either because of past cesareans or the risk of future cesareans, but it is also wrong to prop up a system where physicians can overuse surgery that both harms the health of women and babies, and forces insurance companies to take on excessive costs.” said Gretchen Humphries, ICAN’s Advocacy Director.

Cesarean section is associated with double to triple the cost of a normal vaginal birth. Cesarean also imposes the risks of medical complications in the short-term and long-term, which often carry high costs. “Insurance companies, in their actuarial pragmatism, are doing the math and recognizing that moms with a history of cesarean are high-cost beneficiaries and working to weed them out of the pool of people they cover. It’s discriminatory and lawmakers need to address this issue and determine a way to protect mothers, both from the practices of the insurance industry and the non-evidence based care from obstetricians,” said Humphries.

Maternity care is the number one most expensive line-item in the U.S. healthcare bill. From 1996 to 2006, the national cesarean rate rose by 50 percent, setting a new record each year from 2000 onward. The proportion of medically induced labors rose by 135 percent from 1990 to 2005, with strong suggestions that these official induction rates identify only roughly 50 percent of actual inductions. The burden on the health care system is staggering for maternity care as it is today. In 2005, the combined hospital charges for birthing women and newborns totaled $79,277,733,843 and exceeded charges for any other condition. Private insurers paid for 51 percent and Medicaid paid for 42 percent of these stays. “Pregnancy and delivery” was the most expensive condition, followed by “newborn infants” for both payers. Six of the ten most common procedures billed to Medicaid and to private insurers in 2005 were maternity related. Cesarean section was the most common operating room procedure for Medicaid, private payers and all payers combined.

As policymakers focus on healthcare reform and finding ways to improve outcomes while lowering costs, ICAN calls on policymakers to address the needs of pregnant women and make low-cost, optimal-outcome birth easier to access.

Currently: ·

Few women are given the information they need to navigate the pitfalls of the defensive medicine model of care that is rampant ·

Women are routinely coerced or pressured into expensive care that does nothing to improve outcomes, especially through the increasing practice of banning vaginal birth after cesarean (VBAC) ·

Access to low-intervention midwife-attended births are hampered by reimbursement issues, or onerous collaborative agreement requirements for practicing midwives

“The unique beauty of maternity care is that we can simultaneously improve quality and reduce costs,” said Andrews. “But we need to start by treating women fairly and equitably, and intelligently reserve medical technology and interventions for when they are appropriate.”

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 117 ICAN Chapters across North America, Canada , and various international locations which hold educational and support meetings for people interested in cesarean prevention and recovery.

Citation: C. Sakala & M. Corry. Evidence-Based Maternity Care: What It Is and What It Can Achieve. 2008.

stamp approved and not approved with red text isolated on white

Does insurance pay when you leave the hospital against medical advice?

stamp approved and not approved with red text isolated on whiteThe more I read about women birthing in hospitals, the more stories I read of women who are lied to and threatened.  If we can’t trust our provider, how can we trust when they say we need a cesarean?

Don’t get me wrong, there are great hospital-based providers out there, but it can be really hard for your everyday mom to be able to connect with them. Generally, care providers can be broken down into three categories.  There may be a supportive provider in your area, you just need to know where to look.

Here is an email from a home birth midwife, shared with permission.  In this case, parents were told that if they didn’t comply with the doctors recommendations, and left the hospital against medical advice, their insurance would not pay:

Short version: had a postpartum transport last night and since baby was born OOH [out of hospital] and was a nice healthy 9#, parents had a difference of opinion with the hospital staff about how much input, if any, the hospital would have in baby’s care.

Deciding that staying would be one long argument after another, the parents decided to sign out AMA if the hospital wouldn’t budge on what they wanted to do.

The thing that almost made the parents cave was the OB’s comment that if they left AMA [against medical advice] the insurance could (actually would) refuse to pay for care mom had received.

My understanding is that insurance will pay for the care rendered, but if a patient signs out AMA, the insurance can decline/refuse to pay for subsequent care needed.

Comments or suggestions of where to find this answer.

BTW: a very kind nurse stepped into the situation and convinced the nurse supervisor to compromise.

When I looked into this, I found this 2010 article from Emergency Physician’s Monthly which stated, “Fifty seven percent of all health care providers (and probably just as many patients) believe that if you leave the hospital or the emergency department against medical advice, insurance companies will not pay for the visit. Half of doctors surveyed have told or would tell patients that insurance would not pay the bill if they left AMA.”

Yet, a 2010 study examined how 104 AMA insurance claims were processed by 19 insurance companies and found that each and every one of them was paid.  They concluded, “Our study suggests that insurance companies not paying for ED [emergency department] visits of patients leaving against medical advice is a myth. ” (Wigder, 2010)

This article from the American Medical News cites another 2014 study reviewing the claims of 526 people who left AMA. The only claims that were not paid were due to administrative errors. “Not a single claim was turned down for insurance payment because the patient self-discharged.”

Why does this happen? American Medical News suggests, “People who investigated the issue suspect the myth emerged out of a desire to persuade patients to do what physicians believed was best. Eighty-five percent of residents and 67% of attendings said they told patients this information ‘so they will reconsider staying in the hospital.'”

So while it can be quite persuasive to hear that your insurance will not pay if you leave AMA, it’s simply not true.

Florida law mandates that insurance covers homebirth

Found this blog where another woman uses Florida law to get her insurance to cover her homebirth.

Here is Florida Statute Number 627.6574, but it’s section 7 that spells it out very clearly.  I’ve bolded it for your reading pleasure….

1) Any group, blanket, or franchise policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed under ss. 383.30-383.335.
(2) Any group, blanket, or franchise policy of health insurance that provides maternity and newborn coverage may not limit coverage for the length of a maternity and newborn stay in a hospital or for followup care outside of a hospital to any time period that is less than that determined to be medically necessary, in accordance with prevailing medical standards and consistent with guidelines for perinatal care of the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists, by the treating obstetrical care provider or the pediatric care provider.
(3) This section does not affect any agreement between an insurer and a hospital or other health care provider with respect to reimbursement for health care services provided, rate negotiations with providers, or capitation of providers, and this section does not prohibit appropriate utilization review or case management by an insurer.
(4) Any group, blanket, or franchise policy of health insurance that provides coverage, benefits, or services for maternity or newborn care must provide coverage for postdelivery care for a mother and her newborn infant. The postdelivery care must include a postpartum assessment and newborn assessment and may be provided at the hospital, at the attending physician’s office, at an outpatient maternity center, or in the home by a qualified licensed health care professional trained in mother and baby care. The services must include physical assessment of the newborn and mother, and the performance of any medically necessary clinical tests and immunizations in keeping with prevailing medical standards.
(5) An insurer subject to subsection (1) shall communicate active case questions and concerns regarding postdelivery care directly to the treating physician or hospital in written form, in addition to other forms of communication. Such insurers shall also use a process that includes a written protocol for utilization review and quality assurance.
(6) An insurer subject to subsection (1) may not:
(a) Deny to a mother or her newborn infant eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy for the purpose of avoiding the requirements of this section.
(b) Provide monetary payments or rebates to a mother to encourage the mother to accept less than the minimum protections available under this section.
(c) Penalize or otherwise reduce or limit the reimbursement of an attending provider solely because the attending provider provided care to an individual participant or beneficiary in accordance with this section.
(d) Provide incentives, monetary or otherwise, to an attending provider solely to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
(e) Subject to paragraph (7)(c), restrict benefits for any portion of a period within a hospital length of stay required under subsection (2) in a manner that is less favorable than the benefits provided for any preceding portion of such stay.
(7)(a) This section does not require a mother who is a participant or beneficiary to:
1. Give birth in a hospital.
2. Stay in the hospital for a fixed period of time following the birth of her infant.
(b) This section does not apply with respect to any health insurance coverage that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn infant.
(c) This section does not prevent a policy from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn infant, except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under subsection (2) may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.