In Colorado, complications of pregnancy are required by law to be covered by all health insurance policies, regardless of whether the policy covers routine maternity care. Most of the individual health insurance policies in Colorado do not cover uncomplicated maternity care. There are just a handful of policies that offer maternity coverage as an add-on rider in Colorado, but it’s generally too expensive to make it worth while. So the majority of people here with individual insurance end up paying for pregnancy on their own. But it’s nice to know that if you develop a complication and end up hospitalized for the last month of your pregnancy, you won’t be paying for that on your own. $8,000 is one thing – $100,000 is another story all together.
We got a notice in the mail yesterday from Humana, one of the health insurance carriers we represent in Colorado. They have revised their definition of complication of pregnancy to include cesareans, but not elective cesareans. I was very pleased to see this, and I’m glad that Humana is differentiating between the two. Obviously someone who schedules a c-section ahead of time for convenience would be in the elective cesareans category, but what about a repeat cesarean where the doctor advises against a VBAC? Although VBACs are generally safe, there are a lot of doctors and hospitals that refuse to allow them – probably based more on fear of a lawsuit than on what’s actually best for the mother and baby. But I wonder whether a planned repeat cesarean advised by a doctor but scheduled in advance would be considered “elective”? After all, the mother could choose to go to another doctor or hospital where VBACs are allowed.
And what about the woman who plans to go through labor but changes her mind once the going gets tough? If she asks for a cesarean midway through labor, would that be considered “elective” if she’s already started the labor process? I would hate to be a claims rep having to sort through a stack of cesarean bills to figure out which ones were elective. But good for Humana. If other health insurance carriers – especially for group coverage – were to follow suit, maybe our c-section rate in this country would get down to a respectable level.
