VBAC and insurance

[MittensKittens]

I am looking for information about whether insurance companies generally cover VBACs, or whether they favor repeat c-sections. If you had a VBAC, was it covered by your insurance? Did you VBAC at home or in a hospital? Did anyone pay out of pocket for their VBAC?

Thanks!

[Lisa1970]

Insurance never makes a say in this. I know sometimes, doctors and hospitals like to hide behind insurance as a reason to force people in to things, but all that is false. No insurance in the US will refuse to cover a VBAC and force a repeat csect on someone.

[FischK]

Supposedly, some hospitals' liability insurance disallows VBACs; that's at least what my provider claims and I trust her. However, any private health insurance company would be stupid to not allow VBACs. C-sections are prohibitively expensive, and vaginal birth is a lot cheaper.

[TiffanyToo]

Always call the hospital your birthing at to talk with the administrators VBAC policy.

Call and chat with L&D nurses. They are a wealth of knowledge about VBACs. What OBs are supportive in action vs words. The nurses who love to work with a VBAC mom vs ones who are hostile. Many OBs will give the VBAC ban @ hospital as a way of having to avoid VBAC discussions and births.

[MittensKittens]

Thanks for your replies!

I remember in the Bussiness of Being Born, there was this couple who wanted a VBAC and decided to head for Canada instead (they lived near the border), because it was cheaper that way, even paying out of pocket. I think the issue was that a RCS was covered by insurance, but if they had a VBAC turned RCS, they would have to pay a large portion themselves. Did anyone have this experience?

[LisaSedai]

My insurance (United Health Care) paid for my VBAC in a hospital. It would not pay for my out of state Midwife for a "homebirth" in the MW's home (iit's illegal in my state for MW to attend homebirth) Her rate would have been $2400. My hospital bill was over $11,000, insurance paid all but $800ish. Oh, and I had to pay $300ish for the baby's bill.

[dlm194]

I don't think your personal insurance would prohibit a VBAC.  However, they might not cover health care providers or hospitals where you can actually have a VBAC. 

There are malpractice insurers (for doctors, of course) that will not insure doctors who attend VBACs. 

I have Tricare which is military insurance.  They had no problems covering my VBAC.  They covered my midwives since they were CNMs but they would not cover CPMs.  They would also cover homebirths with CNMs but it's not legal for midwives to attend homebirths in my state. 

[jenniro]

Originally Posted by MittensKittens 

Thanks for your replies!

I remember in the Bussiness of Being Born, there was this couple who wanted a VBAC and decided to head for Canada instead (they lived near the border), because it was cheaper that way, even paying out of pocket. I think the issue was that a RCS was covered by insurance, but if they had a VBAC turned RCS, they would have to pay a large portion themselves. Did anyone have this experience?

I am sure every insurance is different, but I called my insurance company to make sure they covered a VBAC.  They told me they cover my provider, whoever it is (doc or midwife), and whatever they do (VBAC, RCS, CBAC), that is necessary.  So, even though my VBAC turned into a CBAC, it was covered. (I don't think my c-section was "necessary," but that is whole different rant!)
 

[buckeyedoc]

Mine was covered by insurance, and I'm sure they were happy to cover it because it is so cheap!

[jeminijad]

Originally Posted by Lisa1970 

Insurance never makes a say in this. I know sometimes, doctors and hospitals like to hide behind insurance as a reason to force people in to things, but all that is false. No insurance in the US will refuse to cover a VBAC and force a repeat csect on someone.

This is incorrect.

A person's private or group maternity care will not refuse to cover a VBAC- they are going to cover pretty much any approved treatment ordered by an appropriate provider. An obstetrician's liability insurance, or a hospital's, is what restricts VBACs and is a separate subject. It isn't hiding behind anything to become uninsurable after a uterine rupture during a VBAC.
 

[Lisa1970]

I don't buy it. I have seen doctors do VBACs at hospitals where other doctors claimed they could not do it for insurance reasons. So therefore, those doctors are lying. I also do not believe one hospital allows it and then the other does not...when their insurance all comes from the same place. Unless I see this for real, and not just heresay from the doctors, I won't believe it. I will NOT believe the same doctors who try to convince women their babies will die if they do a VBAC that the insurance won't cover it.
 

Originally Posted by jeminijad 

This is incorrect.

A person's private or group maternity care will not refuse to cover a VBAC- they are going to cover pretty much any approved treatment ordered by an appropriate provider. An obstetrician's liability insurance, or a hospital's, is what restricts VBACs and is a separate subject. It isn't hiding behind anything to become uninsurable after a uterine rupture during a VBAC.
 

[FischK]

Originally Posted by Lisa1970 

I don't buy it. I have seen doctors do VBACs at hospitals where other doctors claimed they could not do it for insurance reasons. So therefore, those doctors are lying. I also do not believe one hospital allows it and then the other does not...when their insurance all comes from the same place. Unless I see this for real, and not just heresay from the doctors, I won't believe it. I will NOT believe the same doctors who try to convince women their babies will die if they do a VBAC that the insurance won't cover it.
 

Since I brought this up, let me explain why I think that in the case of the hospital my provider works at, the liability insurance denial seems to make sense. I live in a very rural community, and our county hospital is very small. They are unable to fulfill ACOG-guidelines regarding the immediate availability of an anasthesist outside of normal business hours for VBAC. My provider is pro-VBAC (a CNM who is connected to an OB-practice), and when I know that if I came into the ER in labor and refused a RCS, they would allow me to VBAC. I'm not sure what the rest of the practice thinks about VBAC, but I know that they allow repeat-VBACs and 2% of births at the hospital are in fact VABCs. This puzzles me because I do not see why the liability insurance would differentiate between first and repeat VBACs, and it is the only bit of information that I'm skeptical about.

[roadfamily6now]

Originally Posted by dlm194 

I don't think your personal insurance would prohibit a VBAC.  However, they might not cover health care providers or hospitals where you can actually have a VBAC. 

There are malpractice insurers (for doctors, of course) that will not insure doctors who attend VBACs. 

I have Tricare which is military insurance.  They had no problems covering my VBAC.  They covered my midwives since they were CNMs but they would not cover CPMs.  They would also cover homebirths with CNMs but it's not legal for midwives to attend homebirths in my state. 

I agree. I also have Tricare. All 4 of my VBACs were paid for by my insurance.  I could not think of a reason why a person's own insurance would refuse to pay for a cheaper and 80% of the time successful procedure and opt to pay for a more expensive c-section surgery with a 72+ hour stay in the hospital. Weird.

[roadfamily6now]

If a hospital is not equipt for emergency surgery for VBACs, how can they claim to be able to handle ANY emergency that comes through their doors???

Might as well birth on the side of the road, it will be safer.

[AlexisT]

Lisa, I think there's just a miscommunication there--you're saying the same thing. It's the provider's liability insurance that's the problem, not the patient's health insurance.

As for the couple in BoBB, it could just have to do with the structure of their insurance and how much they're expected to pay. I don't remember that portion of the movie (I only saw part of it) but that doesn't mesh with any insurance I've had. Were they planning a home birth? If you transfer from a MW to an OB in labor, there's 2 sets of charges and it can result in you paying more (you still need to pay the whole midwife fee but now insurance won't pay it), whereas with ERCS, you're with the OB from the get-go, one charge.

I've not heard of a health insurer preferring RCS. It costs them more; they have to pay for an OR, anesthesia, the procedure, a longer hospital stay, and potential complications. If a VBAC goes wrong, they have no legal liability, just a bigger claim. They don't want to push one or the other for PR reasons, but from a bean counter POV, there's no reason to deny VBACs: if it goes well, you pay less, and if it doesn't work, you pay for the RCS you would have anyway. Complications will always occur in either scenario, but I don't think the extra complications from VBAC-turned-CBAC are significant enough cost-wise.

Liability/malpractice insurance is a different beast. From a liability POV, RCS is the more economic option--the dictum is, "You only get sued for the sections you don't do."

[roadfamily6now]

I just spoke with an OB here in Alaska and he said that Some insurance companies will pay him MORE for a VBAC then for a c-section! If he does Global Billing for the VBAC he gets reimbursed about $12,000 but only $6000 for a C-section!!!
 

We told him, he needs to send out a memo to all the other OB's in our state about this! Maybe make a few change their minds.

[MaddieMay]

I have Tricare Prime, where you are supposed to receive all medical care from a MTF (military treatment facility).  My MTF would not allow a VBAC, but I was covered for a VBAC (which ended up being a RCS) 100% with no out of pocket cost to me.