Originally Posted by rmzbm
But again, who decides? That is a very scary thought to me.
Well, under the current model, usually there's some blanket decisions made by the insurance company (we'll cover these procedures for these reasons, but not these for any reason), then the doctor's recommendation determines whether the covered procedure is, in fact, covered. Most HMOs, for example, will cover specialists and lab tests, *if* your PCP referred you and a doctor ordered the test... but *not* just because you walked in and wanted one. (I have this funky weird hybrid insurance with "self-referral," so I CAN just call up an in-network specialist and schedule an appointment, knowing it will be covered, but only pay a co-pay... I like it, but it's always hard to explain to providers when they ask me who my medical group is.)
So, in your case, your doctor says you need a c-section, you get a c-section. Heck, given your medical history, NO insurance company would DARE suggest that it shouldn't be covered. ;-) You worked hard to explore any other option, and couldn't find a single provider who recommended vaginal birth as a safer, or safe, option.
But someone says "Ok, there's absolutely no indication that I can't push this baby out of the hole I came with, but I want a new one anyway." If they can't get a practitioner to diagnose them with something that's a true indication for a planned c-section, then it wouldn't be covered. That's how it works for EVERYTHING ELSE, but doesn't seem to work for this particular procedure, which I think is kinda weird.