National Partnership for Women & Families

Daily Women's Health Policy Report

June 3, 2008

Some insurers recently have denied individual health coverage to women who have had caesarean sections because such women are likely to undergo the procedure if they become pregnant again, the New York Times reports. It is unknown how many women have been denied coverage because of a prior c-section, but the number is "likely to increase" because the number of people seeking individual health insurance has been steadily growing, according to the Times.

The proportion of births delivered by c-section was at a record-high of 31.1% in 2006, with more than 1.2 million procedures performed. According to the Times, a c-section on average costs about $2,700 more than a vaginal birth. Researchers estimate that about 500,000 women annually who undergo c-sections have previously had the procedure. According to the Times, women who have had a c-section can safely deliver vaginally later, but many physicians have begun requiring women to have c-sections because of a small risk of uterine rupture, a potentially fatal complication. Pamela Udy, president of the International Caesarean Awareness Network, said, "Obstetricians are rendering large numbers of women uninsurable by overusing this surgery." She added that women feel pressure to have c-sections that they might not want or need and then be denied coverage for the surgery.

Susan Pisano of America's Health Insurance Plans said that insurers' rules on c-sections vary by company and state, depending on state regulations. She added that some insurers do not factor a prior c-section into coverage decisions, while other insurers consider it a pre-existing condition. Some insurers include a provision that states coverage for a c-section is excluded for a certain period of time, according to Pisano. She said that insurers who do accept women who have had the procedure typically charge higher premiums.

According to the Times, some people familiar with the "rough and tumble world of individual insurance" said that insurance companies' practices in regard to c-sections are "no surprise." Insurers "say they need these strategies to protect themselves because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses," the Times reports. In addition, the Times reports that insurers "often accuse women and obstetricians of scheduling unneeded caesareans for their own convenience -- to deliver the baby at a certain time or to avoid labor." The article profiles Peggy Robertson, a 39-year-old Colorado woman who was denied coverage by the Golden Rule Insurance Company, owned by UnitedHealthcare, because of a prior c-section (Grady, New York Times, 6/1).