Family (De-)values: Caesarian Sections as Pre-existing Conditions

Here’s a new one for you.

Health insurers often deny coverage, especially in the individual insurance market, for a range of recognizable pre-existing conditions: Emphysema, Type A Diabetes, HIV/AIDS, etc.  Insurers argue that such maladies are rarely, if ever, curable and would cost underwriters and consumers millions of dollars annually if covered.  And while some of the diseases that frequently appear on exclusion lists are attributable to lifestyle choices, few arise as a result of a common medical procedure.

Enter the C-section.

According to the New York Times, if you are a woman who has had a Caesarean in the past, the likelihood that you will be deemed insurable in the individual market is remote.  If you can get coverage, prepare to pay more for coverage.  A lot more.

C-sections typically cost more than vaginal births.  In some instances the procedure elevates the risk of surgical complications that increases reimbursement costs for insurers.  Women who have had Caesarians in the past are often more likely to require the procedure in the future.  And many insurance companies beleive that, all too often, the practice is elective rather than medically necessary.

But for many women, Caesarians are not simply a result of a cavalier desire for convenience.  And with few (and widely varied) state regulations governing what conditions insurers can designate for coverage, the C-section has become—albeit for only one gender in the U.S. population—a pariah.

Systemic misogyny aside, such policies lead to a proverbial rock and a hard place for women seeking individual coverage.  Pay exorbitant premiums, hope for an uncomplicated natural birth, or consent to sterilization (yes, you read that correctly: compulsory tubal ligation as a trade-off for access to health insurance).

As more and more consumers are funneled into the individual insurance markets while simultaneously expected to carry the mantle of American Virtue (by populating the country), many women will find themselves financially burdened by unsustainable premium hikes or without coverage at all.  Denials from one insurer can lead to subsequent rejections from other companies, the quintessential definition of insult to injury.  In the absence of affordable access to health insurance, those mothers-to-be face significant risk of incurring medical debt that, more likely than not, will turn from a financial obligation into bad debt, defaults, or bankruptcy.

What a way to bring a child into the world.

Michael Klozotsky will be at the HFMA ANI conference next week. If you wish to meet with him, call him at (217) 369-4075 or email him, even once you arrive in Las Vegas. He’d love to talk with his devoted readers.