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WHY do the insurance companies cover this stuff!?

post #1 of 15
Thread Starter 
Maybe I'm missing something, but I'm starting to feel like proponents of natural birth should get (of all people) the INSURANCE COMPANIES on our side.

WHY are they paying for u/s at every visit? Do they pay for elective c-secs, or do the docs just find some way to justify it on paper? What about epidurals? It takes a specially trained anesthesiologist to come in and stick a needle in your spine, that can't be cheap! Don't they know that statistically (at the most) 10% of woman need c-secs.....aren't they wondering why they're paying big $$ in upwards of 30% of births?

I know why OBs love c-sec....they are high paying and done in a fraction of the time. Not to mention less lawsuits. And my friend who received an u/s at every OB visit during pg....well, of course, her doc had to pay off that machine he had in his office. But what's in it for the insurance companies?

What's going on here?
post #2 of 15
my insurance only covers 1 u\s
post #3 of 15
Quote:
Originally Posted by 2swangirls View Post
my insurance only covers 1 u\s
MIne, too.

I totally agree w/ what you're saying. I think our medical system is messed up. Ins will cover a vasectomy but not a reversal if a man is in pain (friends of mine). It's sad.
post #4 of 15
One woman I knew claimed she was getting a u's every visit because she was too obese for the doppler to work. She didn't seem that big but she was too heavy for the Drs scale.

Doctors can find a reason to justify pretty much anything they do.
post #5 of 15
Thread Starter 
Out of 6 (including myself) close friends that get together each week, 3 had u/s every visit. All had OBs and hospital births. Of the 3 who didnt have them routinely, we had 5 u/s total between us. One of us had a homebirth, I had a midwife/birth center birth and the other had a medicated hospital birth.

Maybe we're setting trends here in nyc?
post #6 of 15
My insurance covers 2 routine u/s, and more if "medically necessary"... ie, high risk, multiples, or you know, whatever the doctor writes down.

About the c/section rates... and insurance convering it... I firmly believe that a woman should have the power to choose whatever kind of birth she wants, even if it's an elective c/s... but she should be fully informed of every aspect of it. That being said, I think that if insurance pays for all of a c/s, it should pay for all of a HB too

What sucks is that so many women are convinced, bullied, or forced into c/s (most by way of interventions that cause "emergencies"), and those moms shouldn't be financially punished for something that is, sure, partially their fault, but mostly the doctor's. Maybe if doctors had incentives to keep the c/s rate lower.... who knows...

Sorry my thoughts are so scattered, it's early and I have pregnancy brain
post #7 of 15
I don't understand why they cover inductions or elective c-sections, yet they wont cover home births.
post #8 of 15
About the epidurals, I can see why they are covering those. Anesthesia is covered for many procedures. I don't see what the purpose would be in denying coverage of epidurals specifically. Women who could afford pain relief could get if if they chose to but women in poverty or without insurance could not? That is a huge ethical issue for me. No matter what your stance on natural childbirth is, I hardly think forcing on women because they can't afford another option is justifiable.
post #9 of 15
I agree, it's ridiculous. I don't think they should deny coverage to anyone wanting those things, but the fact that they'd rather pay for a $7-$10,000 hospital birth, or a $25,000 C-section (and if it's elective, gawd forbid baby is born too soon and needs NICU care), than a measly $3,000 homebirth, just boggles my mind. You'd think they'd be interested in SAVING money, not wasting MORE.
post #10 of 15
The thing is that women think they are getting a good deal when they choose the hospital route (an epidural etc.) , but nowadays almost all insurance is only partial pays. I don't know how people can afford to get an epidural and stay in the hospital for 3 days.

In the 90's I remember someone saying their hospital birth cost all of $20. That was a $10 copay each for mother and child with a HMO!!!!!

In 2004, my epidural and induction (don't get me started on that) but otherwise healthy 'normal' vaginal birth cost $30,000, with a 90% coverage, that meant $3,000 out of pocket for us.

My wonderful birth-center-like hospital birth in 2007, with one night stay and completely natural, no interventions (although I did have a tear repaired w/ pain med) cost us around $1,000 but 600 of that was the hospital copay AND that included all the midwifery prenatal care.

So follow the money trail-- I guess it is worth it for the hospitals to rake in all that dough- why would they discourage the less costly alternative.

Indeed, for insurance companies it shoudl be incentive-- which is why it always pays to try to state your case for compensatoin when homebirth is refused. Every once in a while someone does listen up... but for it to become a trend... there's goign to be a lot more noise.

Jessica

Oh, just remembering that the $30,000 was based on what they actually COVERED, not on what was actually charged for service. The anesthsiologist UAV got paid more than my midwives did for my entire prenatal care. It was so enraging looking at the bills that piled in... I actually had to let that go, caused to much stress and grief, but I so wanted to point out the ridiculousness of it all point by point.
post #11 of 15
It's a complicated issue.

Insurance companies *try* to avoid covering pregnancy and birth, period. Many individual plans have a large additional premium to include maternity coverage. You can't obtain maternity coverage from an individual plan if you're already pregnant, either.

But, once they're covering it... they're in a darned if you do, darned if you don't situation.

Thing is, the availability of analgesia during childbirth first arose as a FEMINIST issue. In order to get access to analgesia, women first had to combat the notion that the pain of childbirth was the "curse of Eve" and that it was immoral to mitigate the pain. While around here, most of us feel that normal childbirth doesn't/shouldn't need analgesia, we also recognize that there ARE cases where it's appropriate and improves outcomes, so if the choice is between no availability and excessive availability, it's probably in the interest of women to have excessive availability.

So... an insurance company that says "you can only have anesthesia if..." is vulnerable to criticism that they are trying to enforce morality, not just control costs. They may also be accused of discriminating against women, since only women are subject to the restriction.

The much more straightforward place where insurance companies are vulnerable is on covering homebirth and midwifery care. In that case, they're simply bowing to pressure from the ACOG etc., and that is a professional ethics issue. Why should they accept the recommendation of an organization with a vested interest in perpetuating inaccurate information about low-intervention birth?
post #12 of 15
I think covering it is fine, but why not cover things that will ultimately lower insurers costs like:
  • Chiro treatment -- studies show lowers sickness, during pregnancy helps with positioning making labor quicker -- and less expensive
  • Child birthing classes
  • Lactation Consultants (some cover as out of network, but it is not esy to recoup)
  • midwives -- Can you believe my insurance plan specifically excludes midwives!!!
post #13 of 15
Quote:
Originally Posted by Ironica View Post
Thing is, the availability of analgesia during childbirth first arose as a FEMINIST issue. In order to get access to analgesia, women first had to combat the notion that the pain of childbirth was the "curse of Eve" and that it was immoral to mitigate the pain. While around here, most of us feel that normal childbirth doesn't/shouldn't need analgesia, we also recognize that there ARE cases where it's appropriate and improves outcomes, so if the choice is between no availability and excessive availability, it's probably in the interest of women to have excessive availability.
I can understand why they cover analgesia, but why elective inductions, augmentations, and elective c-sections when these things have been shown to be more expensive and produce less healthy, and therefore more expensive in the long run (e.g. NICU, troubles breastfeeding, etc.), results? Why are they insisting on paying more money for something that is more dangerous for the individuals involved? Are they incredibly stupid, being payed off by hospitals, or is there some other reason that we are missing here?
post #14 of 15
My insurance covers everything the hospital does, no matter what (I could have an u/s daily if the doc was willing and they'd pay for it) but they won't pay for my homebirth.
post #15 of 15
Quote:
Originally Posted by jennica View Post
I can understand why they cover analgesia, but why elective inductions, augmentations, and elective c-sections when these things have been shown to be more expensive and produce less healthy, and therefore more expensive in the long run (e.g. NICU, troubles breastfeeding, etc.), results? Why are they insisting on paying more money for something that is more dangerous for the individuals involved? Are they incredibly stupid, being payed off by hospitals, or is there some other reason that we are missing here?
My guess is, few insurance companies cover elective inductions or non-medically-necessary scheduled c-sections. However... how do they go about proving that a particular induction or c-section *wasn't* for an approved reason?

Say an insurance company declares "ACOG doesn't accept suspected fetal macrosomia as a valid reason for induction or scheduled c-section, so we're not covering it." Then a woman with totally uncontrolled GD makes herself a 15-pound baby, goes into labor at 41 weeks, encounters shoulder dystocia, Gaskin manouver doesn't really work, baby has a broken clavicle and brain damage. Now she sues the insurance company... because if they'd covered induction and/or elective c-section for that reason, the baby *probably* would have been fine. How much money are they going to pay out for a lifetime of brain damage or other disability? Even if the number of cases like that are miniscule, it only takes a handful of multi-million payouts to totally wipe out the savings from NOT inducing women at 38 weeks and then paying for NICU stays and other complications.

One dysfunction with the private health care system is that there's three parties involved: the care practitioner, who is licensed and trained to advise and make decisions; the client, who is receiving care and giving their (hopefully) informed consent; and the payor, who is *usually* an insurance company. The customer isn't taking relative cost into account with their decisions, because they're not paying. The doctor, too, is not taking relative cost into account, unless their agreement with the insurance company results in making more money from HIGHER cost services. But the insurance company, being neither the licensed professional or the consenting client, frequently can't make decisions about what is and is not appropriate care without being vulnerable to lawsuit.

I had Kaiser coverage for the first 26 years of my life, and while there are Kaiser horror stories (as there are with most HMOs and a lot of hospitals), it did largely address this problem. Doctors get paid their salary regardless of what services they provide. They work their scheduled hours no matter how long a patient takes to give birth or recover from surgery or whatever. They work *for* the payor, and therefore have at least some professional interest in controlling costs. My experience with Kaiser is that they were MUCH more inclined to test thoroughly, employ preventive practices, or suggest natural alternatives than your typical private or group practice doctor. They'd rather spend $1500 on that freaky eyeball blood pressure test they gave my mom back in 1980-something and FIND OUT what's causing her neck problems, than pay a lot MORE down the line by not identifying and addressing the problem. They'd rather send me to the HFS for some melatonin than prescribe some expensive sleep drug.

There are many reasons why health care is a market failure, which explains why the US spends so much more on care per person but doesn't get better health out of it. Birth is one glaring example among dozens of where the system just breaks down. I'm not hopeful that we'll improve the situation dramatically without a really drastic change to how we provide and pay for health care in this country, frankly. The insurance companies, for all the power that they DO have, don't have enough to change things on their own. Same goes for the care providers and the patients. Actually, it turns into something of a prisoner's dilemma situation, where each entity is trying to work in their own best interest... even though if they all cooperated, they'd achieve a better outcome, but if any one entity acts selfishly while another cooperates, the cooperator gets screwed.
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