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#1 of 52 Old 08-24-2005, 11:37 PM - Thread Starter
 
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I am absolutely serious.I read more and more about all the elective sections performed but I have no clue who pays for them.Obviously, if you're not insured, it would come out of your own pocket.But if you're insured, does health insurances pay? Or they don't pay officially and those women convince their doctors to convince the health insurance?Or are some who pay and some don't?Whhich ones would that be?

I'd really like to know how it works in the U.S.
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#2 of 52 Old 08-24-2005, 11:39 PM
 
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Insurance pays for them. At least in my state, a woman has the right to an elective c section. But, usually the dr. finds a reason anyway, just so they don't have to argue it with the insurance...
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#3 of 52 Old 08-24-2005, 11:55 PM - Thread Starter
 
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Originally Posted by leomom
Insurance pays for them. At least in my state, a woman has the right to an elective c section. But, usually the dr. finds a reason anyway, just so they don't have to argue it with the insurance...

There are states giving you the right to one? I am genuinely flabbergasted...Do other states have that law,too?
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#4 of 52 Old 08-25-2005, 12:03 AM
 
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I think I read that these days c-section and regular birthing costs at a hospital are comparable, therefore I don't think insurance companies have that large a stake either way a woman births.
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#5 of 52 Old 08-25-2005, 12:25 AM
 
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Yep. Insurance. And even if they didn't, what woman couldn't find an OB who would find a "reason" to do a section anyway? It is this exact thought that has led me to the personal opinion that only homebirth should be covered for normal pregnancy and birth. Think how it would lower the costs....

-Angela
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#6 of 52 Old 08-25-2005, 01:04 AM
 
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Really? Because I work for a fairly major insurer in litigation on claims, and I'm fairly sure that we actually wouldn't pay for a section unless it was medically necessary. It's a standard exclusion in all our policies.

Now, it might be that docs are writing in phony or fudged reasons for the section and since most insurance claims processing is automated it slips through the system. But if it were truely written up as 'elective', in the too-posh-to-push sense, there's no way we'd pay for it.
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#7 of 52 Old 08-25-2005, 04:06 AM
 
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Insurance, the state, or the patient pays for it.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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#8 of 52 Old 08-25-2005, 04:10 AM
 
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Quote:
Originally Posted by Belleweather
Really? Because I work for a fairly major insurer in litigation on claims, and I'm fairly sure that we actually wouldn't pay for a section unless it was medically necessary. It's a standard exclusion in all our policies.
All a doctor has to say is the patient has herpes or diagnose CPD and the patient gets their caesarean paid for by the insurance company..

The doctor is G-d. Who are you to argue with him?:ignore

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#9 of 52 Old 08-25-2005, 04:14 AM
 
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we actually wouldn't pay for a section unless it was medically necessary
And there in lies the rub. So many OBs tell women it's necessary, and presumably you the insurers, when it's absolutely not. And that goes for elective c-secs too for idiotic reasons like breech babies, pretend pelvis issues, all those irritating ones.

In Australia we have a public health care system so there are far fewer elective c-secs performed there where the govt pays and far more where women pay their private OB or hospital either via insurance or directly. Some of our private hospitals are up over the 65% c-sec rate now and yet they can still get funding and insurance. Madness head Our public hospitals have around a 30% c-sec rate though so they're pretty scalpel happy too.
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#10 of 52 Old 08-25-2005, 04:32 AM
 
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Funny you post this. I was laying awakea little while ago thinking how absurdit is that insurance readily pays for elective c/s! neat timing Anyway, insurance will pay for it, even state medical programs will pay for it. Mostpeople won't pay out of pocketfor it unless they are very welloff because they are generally more expensive. In some places, c/s cost and vag birth cost are comprable. I know that where I am, there are drs who charge almost the same fee for both BUT the c/s still costs more beyond what the dr. gets. I think it's just plain ridiculous that insurance will pay for an elective major abdominal surgery but will argue over paying for heart surgery for children or adults, or for a slew of other life-saving treatments! Why on earth would someone pay, willingly, for me to have a major surgery that puts not one but two people at risk??? Woudln't theys ave more money in t helong run if they promoted vaginal birth? Or maybe if they just started paying for other things that are actually medically necessary...

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#11 of 52 Old 08-25-2005, 05:06 AM
 
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C-sections are cheaper than malpractice settlements.

And if I assert my right to chose a VBAC because I feel the risks are minor enough, I must also assert the right of any other woman to a repeat c-section because she feels the risks are too great. Can't demand birth choice for myself and deny it for someone else, sorry.

Sabra: Mama to Bobbie (3/02), Linda (1/04), Esther (10/05), Marie (11/10), & Douglas (11/12)

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#12 of 52 Old 08-25-2005, 08:39 AM
 
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If a doctor can say a boob or nose job is medically necessary to get insurance to pay, they surely can come up with some BS reason to get insurance to pay for cesarean. And after the first c/s, they don't need a reason for a repeat. But not only have they convinced the insurance companies that it's necessary, but the women having them as well. My very own sister scheduled her cesarean as soon as she found out she was pregnant, for no reason other than convenience and that she had a cesarean the first time. The first one was for her doctor's convenience because he was going out of town the week she was due, baby was born too early and had to be on a ventilator and feeding tube. She never even considered a vbac, it was never an option her doctor presented to her, and she's not one to ever question what her doctor tells her. In other words, she was given no choice. You can call it "elective" cesarean all you want, but most women are not informed nor are they given a choice. She even accused me of endangering my baby's life when I was planning a vbac! I asked her what research she had done to come to that conclusion, it was all "my doctor said..." She never once looked for information other than what her doctor told her. He said her baby would die, and she beleived it, and then tried to use those same scare tactics on me. When I had a wonderful vbac, and didn't even go to the hospital, and my baby was perfect in every way, I think it shook the foundations of her world a little bit.
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#13 of 52 Old 08-25-2005, 09:06 AM
 
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Quote:
Originally Posted by Sagesgirl
C-sections are cheaper than malpractice settlements.

And if I assert my right to chose a VBAC because I feel the risks are minor enough, I must also assert the right of any other woman to a repeat c-section because she feels the risks are too great. Can't demand birth choice for myself and deny it for someone else, sorry.
If you're pro choice b/c a woman should be able to be in charge of her own body...well...wouldn't the same hold true for elective c-sections?


As far as insurance, etc. my doctor gave me a copy of the law that forces insurance to pay for elective c sections. I don't still have it, so I don't know if it was a state or federal law. I guess I could make my husband look it up if anyone really wants to know. But the wording was basically similar to the pro choice wording...her body, her choice.
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#14 of 52 Old 08-25-2005, 12:18 PM
 
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Quote:
Originally Posted by leomom
If you're pro choice b/c a woman should be able to be in charge of her own body...well...wouldn't the same hold true for elective c-sections?
I'm pro-choice, but I don't pay for women's abortions (most insurance doesn't cover them, I know mine doesn't) and so, sure, if you want to schedule an elective c- go for it. But don't ask me (or the insurance...) to pay.

-Angela
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#15 of 52 Old 08-25-2005, 12:20 PM
 
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Why can't it be my body my choice for a hb?

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#16 of 52 Old 08-25-2005, 01:58 PM
 
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Quote:
Originally Posted by WinterBaby
I think I read that these days c-section and regular birthing costs at a hospital are comparable, therefore I don't think insurance companies have that large a stake either way a woman births.
Yeah, I can't believe how much my unmedicated vaginal birth in a hospital cost. It was outrageous. I find it hard to believe that a c/s doesn't cost the hospital more.

Heather Mike Married 8/1/99 Mom to Charlotte Aug 04, Nov 06, and Katherine Oct 07
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#17 of 52 Old 08-25-2005, 02:04 PM
 
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Originally Posted by Belle
Yeah, I can't believe how much my unmedicated vaginal birth in a hospital cost. It was outrageous. I find it hard to believe that a c/s doesn't cost the hospital more.

My cousin told me hers cost in the tens of thousands, (she said $60,000, but i think its probably an exageration.) But still... even half that is a LOT more than my natural vaginal delivery.
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#18 of 52 Old 08-25-2005, 02:41 PM
 
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Quote:
Originally Posted by alegna
I'm pro-choice, but I don't pay for women's abortions (most insurance doesn't cover them, I know mine doesn't) and so, sure, if you want to schedule an elective c- go for it. But don't ask me (or the insurance...) to pay.

-Angela

Not quite sure how you can compare insurance companies paying for an abortion to paying for an elective C/S...

Until you have been in the position of worrying about having a VBAC then you really can't say that it is wrong for a woman to schedule an elective C/S after a prior C/S.
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#19 of 52 Old 08-25-2005, 02:51 PM
 
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I could be wrong, but I get the feeling this thread is aimed more at "convenience" sections. The term "elective" is misapplied all over the place where sections are concerned. It infuriates me.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
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#20 of 52 Old 08-25-2005, 02:59 PM
 
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Yeah- it started as a discussion of "elective" sections. As in, too posh to push... lol love that term. Anyway, I only brought up the abortion thing to answer a pp.

-Angela
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#21 of 52 Old 08-25-2005, 03:30 PM
 
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Quote:
Originally Posted by Belle
Yeah, I can't believe how much my unmedicated vaginal birth in a hospital cost. It was outrageous. I find it hard to believe that a c/s doesn't cost the hospital more.
The site is down but the hospital closest to me has a prepayment plan for birth. I think c/s was double what unmed birth was. But the site is down and I can't remember exactly but I think it was $1800 for unmed and $3600 for c/s. And of course this is for out of pocket not insurance companies. I am sure they get alot more from insurance co than they do from out of pocket since thats always the way it works.

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#22 of 52 Old 08-25-2005, 03:37 PM
 
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Quote:
Originally Posted by WinterBaby
I think I read that these days c-section and regular birthing costs at a hospital are comparable, therefore I don't think insurance companies have that large a stake either way a woman births.
By the time you factor in the IVs, epidurals, monitors, etc. that have become a "normal" part of birth, I wouldn't be surprised if that's true. You have to pay for a lot of the same things, either way.

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#23 of 52 Old 08-25-2005, 04:38 PM
 
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Quote:
Originally Posted by alegna
I'm pro-choice, but I don't pay for women's abortions (most insurance doesn't cover them, I know mine doesn't) and so, sure, if you want to schedule an elective c- go for it. But don't ask me (or the insurance...) to pay.

-Angela
Would you be against insurance companies paying for abortions?
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#24 of 52 Old 08-25-2005, 05:00 PM
 
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Originally Posted by leomom
Would you be against insurance companies paying for abortions?

It would depend. I would be against them paying for SOME elective procedures and not ALL elective procedures. (for the sake of argument I'll leave out medically needed terminations... that's a different issue) I am not against the idea of insurance covering abortion. BUT if they do, then in my mind they should also cover birth control, homebirth, nose jobs and any other medical anything that the people want.

how's that for confusing?

-Angela
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#25 of 52 Old 08-25-2005, 05:17 PM
 
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Careful speaking about abortion. If I recall, threads have been yanked for such discussion, though I never really understood why (I guess I missed whatever happened to cause that being a huge no-no topic around here)

Elective vs Convenience -- Well, yeah, I think we're talking about convenience c/s. Though for what it's worth, I'd rather see insurance pay to encourage women to have VBACs, encourage the medical community to provide information towards making sucha choice, than forthem to just pay for c/s. No offense meant to anyone who has had to face the decision of whether to VBAC or not, especially in these newly-hostile anti-VBAC timesat many hospitals.

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#26 of 52 Old 08-25-2005, 07:21 PM - Thread Starter
 
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Quote:
Originally Posted by leomom
If you're pro choice b/c a woman should be able to be in charge of her own body...well...wouldn't the same hold true for elective c-sections?


As far as insurance, etc. my doctor gave me a copy of the law that forces insurance to pay for elective c sections. I don't still have it, so I don't know if it was a state or federal law. I guess I could make my husband look it up if anyone really wants to know. But the wording was basically similar to the pro choice wording...her body, her choice.
I'd be very interested
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#27 of 52 Old 08-25-2005, 07:22 PM - Thread Starter
 
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Quote:
Originally Posted by Storm Bride
I could be wrong, but I get the feeling this thread is aimed more at "convenience" sections. The term "elective" is misapplied all over the place where sections are concerned. It infuriates me.
I mean those without a real hard medical reason....some obviously for convenience I suppose.
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#28 of 52 Old 08-25-2005, 07:34 PM
 
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I think the problem really for insurers is that we just don't have the staff or even access to enough people with the training to go through every claim we get for a CS and pick out from the notes in which cases the medical reason is bogus and in which cases it isn't. My regional insurance company alone processes over half a million claims a day... so unless there's something wrong, on our end most of those claims never even get seen by a human being. Just scanned in, run through a computer and a reimbursement pops out the other end.
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#29 of 52 Old 08-26-2005, 06:02 AM
 
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In the UK (around a 20% c-sec rate so slightly better than US and Australia) each c-sec goes before a peer review panel and the OB has to justify it. That would alleviate the problem of insurers having to do it.
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#30 of 52 Old 08-26-2005, 07:33 AM
 
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I was actually referring solely to matters of birth choice. I demand the right, as an intelligent, thinking individual, to decide that I consider the risks small enough to take. And I cannot, in good conscience, demand my right to a VBAC while denying another woman her right to an ERC. I am well aware that there are other reasonable, intelligent women out there who can look at the same statistics as I, and decide that any risk of uterine rupture is too much.

By the same token, if she should be forced to justify her c-section, I should be forced to justify my VBAC.

Sabra: Mama to Bobbie (3/02), Linda (1/04), Esther (10/05), Marie (11/10), & Douglas (11/12)

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