5:10 PM Eastern - Thursday, September 17, 2009

Insurance Companies Consider C-section Birth "Pre-Existing Condition"

Insurance companies in most states can cite pregnancy as grounds to deny women coverage based on this
Insurance companies can cite pregnancy as grounds to deny a woman coverage based on her "pre-existing condition."
If you think insurance companies have gone too far claiming that "domestic violence victim" is also a pre-existing condition to deny coverage to countless Americans, you may be appalled to hear this isn't health insurers' only policy that discriminates against women.

The Pregnancy Discrimination Act of 1978 requires employers with more than 15 workers to include maternity benefits in their insurance packages. However, as Think Progress reports today, only 14 states require comprehensive maternity care to be included in coverage in policies sold on the individual market. Most individual insurers don't cover maternity care, and the number of plans without maternity coverage continues to rise dramatically.

The realities of this are shocking. Freelance author Sarah Wildman discovered the hard way that most insurance companies on the individual market consider pregnancy "optional." The fetus is viewed as an uncovered "pre-existing condition," and therefore not something that's necessary for insurance companies (like Anthem Blue Cross) to insure.

"The point of insurance is to insure against catastrophic care costs. That's what you're trying to aggregate and pool for such things as heart attacks and cancer," said an Anthem Blue Cross spokesman. "Having a child is a matter of choice. Dealing with an adult onset illness, such as diabetes, heart disease, breast or prostate cancer, is not a matter of choice."

After giving birth to her daughter, Sarah and her husband racked up more than thousands in medical bills--to the tune of almost $25,000--despite the fact that she had maternity insurance. Being self-employed, Sarah falls into the individual insurance market, along with an estimated 27 million other Americans who are also freelancers, entrepreneurs, transitioning out of college/grad school, or newly unemployed, according to the American Medical Association. As more and more Americans lose their employer-based coverage--an estimated 17,000 do every day--this number will keep steadily rising.

Yet as unsatisfying as individual market coverage is for many Americans, it's also easily taken away, especially if you fall in to the approximately 30 percent of women who have a Cesarean section. Many insurers consider a Cesarean section pregnancy a "pre-existing condition"--and refuse to provide health coverage for women who have had the procedure.

Sarah joined members of the congressional Joint Economic Committee on Capitol Hill last Thursday to give her testimony:

Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy--riddled with holes and exceptions--that the health care reform bills in Congress should try to do away with. The "maternity" coverage we purchased didn't cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of [our daughter's] life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.

Even when a woman isn't currently pregnant, she often still cannot get coverage. Because as Think Progress points out, once you're denied by one insurance company, it's harder to get coverage somewhere else because you've been red-flagged. "After 36 hours of labor, I ended up having a cesarean section," said Sarah. "Now I'm considered at risk of having a second; the c-section is a pre-existing condition."

The rationing of health care through gender discrimination results in women being charged up to 48% more in premiums than men for the same coverage through the individual market. Right-wing opponents of reform say they don't want government-controlled, "rationed" health care. But by financially punishing mothers this way, the insurance industry is throwing more barriers in the way of parents (and parents to-be) than the government ever could. Sarah and her husband would most probably argue their beloved daughter is worth the $20,000+ (and more) they were billed for bringing their child into this world. The bigger point is that in America, it shouldn't be this way.

A Consumer Reports study published in May found that "many people who believe they have adequate health insurance actually have coverage so riddled with loopholes, limits, exclusions, and gotchas that it won't come close to covering their expenses if they fall seriously ill." It's clear that insurance companies refuse to police themselves. It's up to us need to call on Congress to take action now to pass health care reform and end discrimination against patients with pre-existing conditions.

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