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Had a C-section and worried about future insurance coverage?

By June 1, 2008 - 7:34pm
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I'm wondering if there are any moms out there who've had one or more C-sections and are having trouble with their insurance coverage. There's a cover story in today's (6/1/08) New York Times about how women have been refused coverage or else have to pay high premiums because they've had C-sections in the past.

I'm absolutely appalled by this and feel this is awful discrimination! In the article, a 39-yr-old woman in perfect health was denied individual coverage by the Golden Rule Insurance Company, (owned by United Healthcare), because she'd had a previous C-section and therefore was considered "at risk" for a future C-section since she'd not been sterilized. According to the article, a C-section costs an average $2,700 more than a vaginal birth, and Golden Rule didn't want to have to pay this extra cost. In some states, Blue Cross Blue Shield charges much higher premiums to women who've had C-sections. And there are many other insurance companies that treat C-sections as pre-existing conditions and will not provide coverage unless a woman has been sterlized.

Has anyone encountered this issue?

Add a Comment13 Comments

Our insurance company went bk and Golden Rule took their policy holders on. They did NOT put an exclusion on c-section for me (had one with my twins almost 7 yrs ago). We did not opt for maternity coverage. The policy did however cover complications INCLUDING c-section if it was medically necessary. Here's the upsetting part... We live in a rural area and our hospital will NOT allow VBAC's. I would have to drive up to 3 hours to attempt this. Not best case senario. So my doctor wants the c-section done here as do I. Golden Rule WON"T cover it because it's now considered elective EVEN THOUGH our hospital will only let me deliver that way. Obviously I've called and now I'm going to try and write to Golden Rule regarding the issue. Unfortunately I'm not expecting much. Seems to be a trend here with Golden Rule. Sad. I had them back when my twins were born and didn't seem to be this bad. It's a shame what our government has done to health insurance.

February 10, 2011 - 2:47pm
EmpowHER Guest

I am so frustrated with the healthcare system. I was just denied maternity insurance due to having a miscarriage a year and a half ago. Blue cross informed me I had to wait 5 years before they would cover me now that I am "high risk". So now I am being "punished " for a miscarriage!!!! Not to mention with the first pregnancy I was denied for it being a "pre existing" condition. Insurance companies do not help you they try to find loop holes to Screw you!!!!

March 15, 2010 - 8:43pm
EmpowHER Guest

This is so outrageous! I am in the same situation with Golden Rule. All coverage is denied for two years if I have any complications attributable to my previous section or have a future c section. I am so angry that I am being forced to consider how and when to plan my family based on the discriminatory rules of an insurance company!

May 17, 2009 - 12:24am
EmpowHER Guest

I had my first child via c-section, and discovered yesterday that I've been "conditionally approved" for coverage through Blue Cross Blue Shield of Illinois with the exception of future c-sections. Not only do I have to wait 1 year to the start of my coverage date to get maternity insurance, now they're telling me how I'm able to deliver my child. I was told by a representative that I'm covered for all maternity related dr's visits, tests, etc. (starting at the 1 year mark), and everything in the hospital up until the time the Dr. starts cutting with his knife to deliver the baby. How messed up is that? I cannot believe that an insurance company has the gall to dictate to a woman HOW to give birth. Even if it's an emergency, it's still not covered because they are considering it a "pre-existing condition". I'm completely flabbergasted and am in the process of appealing this ruling. If anyone has had any run in with this in the past, any feedback would be greatly appreciated.

April 16, 2009 - 5:13pm

I am so happy you wrote about this! I am very angry, as I've encountered the exact same discrimination.

I have been trying to find health insurance for myself and my family as individuals; we do not have an employer-paid insurance option. I also need maternity coverage, as we are hoping to have more children in the future.

Golden Rule did exactly as the above article mentioned: they denied coverage of not only my previous pre-term labor (which is VERY common, and I had no other complications from this!), but also would not cover any future pre-term labor...AND...they freakin' threw in EVERY OTHER POSSIBLE CONDITION AND PREGNANCY COMPLICATION AS WELL! NONE of which I had before, so they are not "pre-existing" conditions. They just did not feel like offering coverage. These "other" conditions that they threw in included: pre-eclampsia, c-section, hypertension...even miscarriage! How awful is that!?! I do not have any of these risk factors, and to imagine an insurance company that I'm paying big bucks for would drop me if I had a miscarriage...I can't imagine...

Another Texas-only insurance company, Scott & White, which is supposed to be more progressive, flat-out denied all three of us because they did not want to provide maternity coverage. At least they didn't pretend to offer maternity coverage like Golden Rule, but they ended up being worse because our family was not able to obtain any type of insurance through Scott & White. Shame on them.

So, we're left with health insurance that does not offer any-type of maternity coverage, unless it is an emergency for me or the baby.

I am beyond angry about this. We were open to paying the extra $300-$500 per month for maternity coverage, for "only" $2,500 coverage. That is absurd in and of itself. This is the unbelievable part: we were denied this minuscule amount of coverage, and would have ended up giving them much more in premiums that what the benefits were...they just did not want to actually provide insurance for something that we might need. It is pure discrimination for women of childbearing years.

My only options now are to stick with our current insurance, and hope that nothing goes wrong. If everything is "perfect" (is there such a thing?), then we'll end up paying out-of-pocket. If there is a problem, then perhaps the insurance will cover it, depending on if it is considered an "emergency" or not.

To advocate for myself, I will be talking, in advance, with the hospital and doctors, to see what type of discount they can negotiate with me since I'll be paying cash (they negotiate rates with insurance companies, and can reduce their rates for individuals paying cash and/or paying in advance).

I also went to insurance sites that have feedback options (www.ehealthinsurance.com), and provided information about these two companies (the less emotional and more facts on these sites, the more credible the feedback sounds. I'm glad on this site I can get the emotional part out!). Please spread the word about health insurance discrimination, and write to your local, state and national politicians. Respond to the NY Times article online, so others can see as well!

February 8, 2009 - 7:30pm
EmpowHER Guest

I had a c-section 2 years ago with my first child at the time I had group health insurance. I now have individual health insurance for my family with BCBS with maternity coverage(total policy 1280.00 every 2months,maternity 360.00 every 2 months)I was made to sign a PERMENANT EXCLUSION that if I had another c-section BLUE CROSS BLUE SHEILD OF ILLINOIS would not cover anything related to and including the c-scetion or complication thereof. I can't have another baby because of this. I have searched about a million an one companies and can't find anyone to cover me. Some one please help

October 23, 2008 - 11:29am
EmpowHER Guest
Anonymous (reply to Anonymous)

I have the same exact situtation as you do. I had group and now I have BCBS, also. I had to sign the same exclusion. Which is so not fair. Because my 1st child was born through emergency c-section. I pushed for hours. I think they should cover it if it is medically necessary. My doctor has recommended me to have a 2nd c-section(which I did in August). Right now it has cost an additional $7,000.00. Not covered was the surgery, assisiting doctor and anesthesia. But they will cover an epidural in natural childbirth...what are we paying for?? I am so upset!! My advice to you is let your water break, then your doctors will have to do an emergency c-section(bcbs will only cover it in an ER situation, not scheduled). Which I will do for my next kid. Best of Luck!! I just wanted
you to know, it sucks and I know how you feel!!

January 7, 2009 - 5:36pm
EmpowHER Guest
Anonymous (reply to Anonymous)

I wouldnt even try that. aug 15th 2006 I had my first daughter cambria. I went into labor 3 weeks early. I was in labor for 18 hours and wouldnt dialate no matter what they tried. Soon she became distressed and heart started dropping quickly. I had already has 2 epurdurals ( sry about spelling LOL ) because im 5'0 and the stuck me in the wrong spot in which made my chest numb and I couldnt breath, the 2nd just didnt work. So i get into the or they do my c section everything turned out fine. I go home and 2 days later had to go back because my staples on the left side had broken in a few spots. They kept me for 4 days due to an infection. a yr later blue cross blue sheild sends me a letter stating they will not pay ANY of the bills from my delivery. So i was charged for 2 epurdurals ( shouldnt hav cuz they screwed up), the surgery, 4 dr's, the stay, nursery all the medication. So now I owe 15,849 and they wouldnt take payments or anything. I talked to blue cross they said that they werent perfered providers (my dr's that is) HOWEVER, it states that if there isnt not another provider with in 150 miles they will cover ( and there wasnt I lived in the middle of no where)and it was an emergency situation. what was I suppose to do? be like im sorry guys I know im in labor and need this c section but I need to drive 250 miles to reno nevada of 170 to salt lake ut because my insurance WILL NOT PAY YOU im sorry. So after they told me that crap I talked to them and they said they would resubmit because they would cover, 6 mo. later I find out there never did! and it had gone to collections and now has late fees and stuff. My last job offered me blue cross, I told them I would rather go without then ever deal with those morons! Man I hate them so much for screwing my credit just because they are scam artist! -

May 24, 2009 - 11:07pm
EmpowHER Guest

I got golden rule after my first child was born via c-section and they put me on a probationary period of 3 years. They said that I couldn't have a baby before that if I wanted to be covered, if I did I would be paying out of pocket (about $11,000.00)! I just had my second child via c-section and am trying to get self coverage because my husband has been laid off (we had group coverage for the second one)and I'm running into the same problem as before. There asking me if I plan on having any more children? Is that a problem? It's a child, a life, not a condition! Even if it was, I'm paying for a service, it's like turning away a colored person because of the color of their skin.
They would rather you be sterilized than bring a living breathing person into the world, a future costumer might I add!

October 13, 2008 - 6:04pm
EmpowHER Guest

This is pretty nasty. Group insurance coverage would be preferable. Maybe Governor Arnold, will do some insurance reform here in California to address this here. He already has done some good stuff in that direction.

September 23, 2008 - 10:11pm
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