Monday, March 16, 2009

If I Were an Insurance Company, I Would NEVER Pay For an Elective C-section

If I were an insurance company, I would not allow women to choose to have a C-section for no medical reason.  It would cost me twice as much money as a vaginal birth.  I would, however, be happy to pay for out-of-hospital births, as it costs me a fraction of the money a hospital birth does.

Oh wait, the only people I actually listen to, as an insurance company, is doctors and hospitals, who have a financial interests in these policies.  This is not about evidence-based care.  It's about putting the doctor on a pedestal and ignoring the midwife.  The doctors are thrilled to allow a woman to selfishly choose to have a C-section because it fits nicely into the doctor's schedule, and, oh yeah, cha-ching, it's twice as much money!  The doctors have done a great job of convincing me, the insurance company, how dangerous, reckless, and incompetent a midwife, especially a CPM or LM, is -- the smear campaign rages on against midwives.  

How can I, as an insurance company, in good judgement, take the advice of people who stand to gain financially by their recommendations?  The majority of doctors are trained to believe that birth is dangerous and needs to be managed.  The only place this can be done is in the hospital. They are convincing the insurance companies that homebirth is unsafe and women who choose to do this are placing their babies lives at risk.  (But let's go ahead and make abortion legal and accepted.)  Birth is safe for mothers and babies, as most midwives know and believe, because they see it and live it, day in and day out.

I have had a number of students who have wanted to have their baby at home or at a free-standing birthing center, only to be told that, no, they may only give birth in the hospital.  They have a choice of several doctors but only one or two midwives.  But if I am an insurance company, and I am in this for money, why am I ignoring a viable option -- homebirth?  Why, from a financial standpoint, am I covering a woman to have surgery to remove her baby because she is too scared to go through labor and give birth vaginally?  (I am not even going to address the moral and physical reasons why this woman is an idiot.)  I am paying thousands of dollars for a procedure that in 100% unnecessary.  The irony is so thick, it makes me sick.  And women who want to spend a fraction of what they would be allowed to spend if in the hospital are denied that option?  Unbelievable.  

When will the insurance companies begin to listen to midwives and to informed consumers who want to birth their babies at home?  We have to speak up to be heard.  Insist on options from your insurance companies.  They have to provide you with options.  I actually had my first homebirth reimbursed by our insurance company because they failed to give me all the information when I insisted that I needed options.  They could not make me give birth at that one hospital.  There was another hospital they were contracted with, but I was not given that information until the baby was 5 weeks old.  After 3 appeals, I had a hearing where we all sat around a big conference table listening to the recording of the phone conversation where I was told that I had no options.  Needless to say, we were fully reimbursed for our entire homebirth. But we didn't know that would happen at  the time we hired our midwife and we still made the choice to pay, out-of-pocket $2500, instead of our $100 co-pay at the hospital.  

I am not a fan of going into debt, but I do believe that sometimes we have to take our healthcare into our own hands and not leave it to the insurance to make all our choices for us. Fight for your right to birth your baby where you see fit.  Maybe, just maybe, we'll be heard. It's more important now than ever, as the AMA is on a campaign to make it impossible for homebirth midwives to practice.   If a woman wants a homebirth, she would have to illegally hire a midwife to attend her birth.  This is wrong.  Women deserve this choice in childbirth. They can legally kill their babies through abortion and choose to have them surgically removed from their bodies, but they can't lovingly and fearlessly birth their babies in their own homes and beds with midwives who believe in the natural process of birth.  


Scott and Hannah said...

Someday, hopefully in my lifetime, I will see home births covered. Wouldn't that be awesome!?

Anonymous said...

I totally agree with where you're coming from but feel as women we need to be very careful about how we treat women who choose to have hospital medicated vaginal births. Just like some people decide to do birth via a midwife some people choose to do it via doctor and medication. While I do not agree it does not help the case of home birth, natural birth, or birthing centers to try and force it on other women. I feel we must ban together and educate women then move from there.

That said it is a darn shame the things insurance companies choose to cover and not to cover and the convoluted reasons behind these decisions.

Donna Ryan said...

My issue is not really with the women choosing to have an epidural, but rather those choosing a C-section without ever experiencing a single contraction. Insurance should not cover them.

Women choosing the epidural should realize they are 4 times as likely to have a c-section that a woman choosing to not have drugs. I simply don't understand what would possess a woman to go straight to a c-section and not even a vaginal birth with an epidural. An epidural is definitely the lesser of the two evils.

I believe, however, that the reason women choose to have drugs is because they are afraid. Education, a supportive birth team, and trust in your body are key. I truly believe that nearly all women CAN do it.

I wasn't really trying to pick a fight with the epidural bunch in this post. It was really against the insurance companies covering unnecessary c-sections and not covering homebirth.

Urban Tangerine said...

I totally agree about not insuring elective C-sections. To me that's like getting an elective feeding tube. It's ridiculously risky and there are inexpensive, simpler and more enjoyable ways to get the food. It's the same with birth. Women have so many options to experience all or none of labor and everything in between. Lack of education really is the disconnect, but you would think that even insurance companies would be savvy enough or greedy enough to recognize the cheapest viable option. In school we learn how to have sex, but we really don't learn how to have babies. We have no longer have a cultural forum where women learn to trust their own bodies. Why is something so universal, so mysterious?

My insurance covered all four of my hospital deliveries, but only 60% of my homebirth. I'm still working on that.

Kate's mommy said...

Sort of off-topic - Dr. Cummings spoke at our last ICAN meeting. He mentioned that in the past the insurance companies paid a significant amount more to dr's & hospitals for a c-section vs vaginal birth (average of 50% more). Not to mention the 'time' savings to the doctor since he can eat dinner w/ the wife & kids & the hospital can free up another labor room. He said that this alone has contributed greatly to more dr's doing c-sections to get paid more, and the insurance companies are FINALLY wising up. They have helped to create monsters!! He did say that doctors still get paid more for the surgery, but insurance companies are trying to reduce that financial incentive for doctors and lessen the gap in pay for a vaginal vs c-section birth.

It's a weird world we live in!!

Donna Ryan said...

Sarah, that wasn't off topic at all! I am glad to hear the insurance companies are wising up. It was very controversial when ACOG came out with their statement that women could choose a C-section over a vaginal birth as a method of getting their baby on the planet. It's surprising that the insurance companies ever went along with it.

Urban Tangerine, that's great that you have gotten 60% of your homebirth covered. I hope you get even more. I actually ended up getting both of our homebirths payed for when we lived in NM. In TX, however, I haven't heard of anyone getting their homebirth covered by insurance.

Medicaid is a whole different story. They will usually pay for a homebirth, which is great. Definitely helps the state, financially speaking.

I have heard of women being denied coverage, or their coverage being outrageously high, because of previous c-sections. I think this will be a new trend. Unfortunately, it seems as though the women are being punished, but in reality, a lot of them likely didn't want the c-section, but their doctor pushed for it. I would like to see the doctors punished instead of the women. Women have suffered enough at the hands of these greedy doctors.

Anonymous said...

I got to your blog from another blog I read. I've been perusing through and can I just say "THANK YOU!". Holy cow, I love it when other people are so into natural birthing and attachment parenting! I mean, hello, my body was made to give birth and seeing as my mom, her mom and her mom, etc, were able to birth without needing meds, I think we can still get through the process naturally. I mean, why spend 9 months sheltering and protecting your little one, just to fill 'em up with drugs so you can don't feel so much pain.

Kimberley said...

My (economist) husband thinks the same thing ;0) As do I of course! :D

Betsy T said...

It is my understanding that insurance companies make more money from premiums than they do from "not paying" for services. If the medical costs go down - as they would with home births and natural vaginal births - they have no excuse to raise premiums. The ONLY goal of insurance companies is to have a profit at the end of the fiscal year for the shareholders. PERIOD! Having insurance does not make you healthy, and your best interests are not theirs.

The Mommy Blawger said...

I've had two Texas homebirths (and one Idaho homebirth) covered by insurance. They took a long time and did some wacky things with the claim, but they paid it in the end without my even having to go lawyer on them.

AnonymousAbortionMe said...

*But let's go ahead and make abortion legal and accepted.* and *They can legally kill their babies through abortion and choose to have them surgically removed from their bodies*

Abortion is an absurd and disingenuous point to bring up. This was a great article until you spun off into a wild, completely unrelated tangent.

It would be more appropriate to point out that when a certain procedure is not covered/reimbursed by insurance companies (circumcision for example) the rates drop significantly. Such would be the case if insurance companies stopped reimbursing elective c-sections.

While I understand you do not agreed with abortion, bringing it up arbitrarily because you disagree with it diminishes the power of your argument and undermines the article.

Ps - Despite being pro-choice I love your blog and have found most of your insights to be keen and wise.