Caesarean Section Raises Health Insurance Rates

Did you know that having a c-section could raise your health insurance premiums or even get you denied for coverage? If not, you're not alone. This was news to Peggy Robertson when her application for health insurance was denied last year. The insurance company gave the reason that, because she had had a c-section in the past, she would be likely to need one in the future if she were to become pregnant again. Naturally, the insurance company did not want to pay for this operation again. They offered her the alternative of sterilization, which is unappealing to say the least.

The Background

With individual insurance coverage, unlike group coverage, most companies are allowed to dictate which people and conditions they will cover. They are also free to base the premiums on the person's medical history. In some instances, a c-section means higher premiums. It's unclear how many other women face Ms. Robertson's plight, but the number is likely substantial and growing. The number of people seeking individual health insurance has reached 18 million, and the Caesarean rate has reached an all-time high of 31.1% of all births. Consequently, obstetricians are rendering many women uninsurable due to their overuse of the surgery.

Conflicting Voices

Women applying for health insurance are faced with a confusing triangle of doctors, hospitals, and insurance companies all pulling them in different directions. Doctors may push the surgery on some women unnecessarily, which carries medical risks and well as insurance repercussions. In addition, there are no guarantees that the woman's existing policy will even cover the surgery. However, some insurance companies will ignore past c-sections, while others will treat it as a pre-existing condition.

Possible Solutions

Some insurance companies are willing to offer riders that exclude coverage for a Caesarean for a certain period of time. On occasion, applicants with previous c-sections will be charged higher premiums and deductibles. In many ways, then, having a c-section is very similar to patients who have chronic illnesses or other conditions that may make them uninsurable. However, if women who have had c-sections are willing to pay the higher premiums and forgo coverage on future Caesarean surgeries for a limited time, getting insurance is possible.