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Your Insurance Company Doesn't Want You to Have a C-Section

by Michele Zipp on July 15, 2012 at 10:00 AM

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We have far too many interventions when it comes to birth, which can be one of the most natural things in the world. It's how us humans continue to populate the Earth. Most times we have sex the old fashioned way and therefore we can birth the way they did in olden times, too. Because it's human nature. But somewhere along the line we stopped trusting birth. Could you imagine if you stopped trusting sex? And had to have a doctor there to facilitate the experience ... with drugs?

I fault some of the medical community for poisoning our minds into thinking we need drugs to have our babies. And then we need more drugs. We need to schedule this. We need to get baby out now way before it's time. Let's schedule a c-section because the holiday is coming up and I want to go on vacation with my family so let's get this baby out.

Well, this just in! Insurance companies are basically telling hospitals to stop the c-section epidemic.

If you didn't believe there is a c-section epidemic, this may convince you. Insurance companies, often known for giving us a hard time with pre-existing conditions and required referrals and all the scary "This Is Not A Bill" paperwork, are feeling that hospitals have gone overboard with this expensive procedure and they're saying it's far too often unnecessary. Aetna and Cigna are leading the way.

Okay, maybe you are thinking it's because they don't want to pay. And yes, that's part of it. But think about this: C-sections cost on average $24,300 while a vaginal birth is around $15,200. Meaning doctors and hospitals make more money off c-sections. A lot more. And the attending doctor is the one who makes the money. Hence the scheduling so your doc can be there and take home the cash. Vaginal births can happen at any time, naturally, and if your OBGYN has a vacation coming up around your due date, he or she won't get paid if your baby decides to come when that doc is beach-bound.

I know it's not always like that. Maybe your c-section was necessary. Very necessary. Mine was. I get it. We need that knowledge and cesareans do save lives. But things have gotten out of hand.

Interestingly, Aetna wants to adjust prices for c-sections. And Cigna is considering the same, along with giving bonuses to hospitals who reduce early cesareans and inductions. This is wonderful news. Incentive. And if it happens, and if more or all insurance companies follow, I really believe our c-section rate will decline to a number that makes sense.

I wonder if more homebirth coverage is next?
 

This isn't just about having a vaginal birth. This is about the safety and health of baby. It's been cited in a 2009 study in the New England Journal of Medicine that babies born at 38 weeks had twice the amount of medical problems compared to those born at 39 weeks. Every week is vital when in utero. The risk of complications at 37 weeks is nearly four times as much. 

One doctor is speaking out and making sense. Joshua Copel, who is now a Yale University professor and former president of the U.S. Society for Maternal-Fetal Medicine, said: “For anything elective, most of us believe that 39 weeks and zero days is the absolute earliest any delivery should occur.”
 
I hope this becomes the standard once again.
 
What do you think of the stance Aetna and Cigna are taking with c-sections? Do you think this will curb the epidemic?

 

Image via one tiny spark/Flickr

Comments

56
  • Cass
    -- Nonmember comment from

    Cass

    July 15, 2012 at 10:22 AM
    Uh huh. And what happens when a hospital, trying to reduce its C-section rate to get the bonus, delays or even denies a necessary c-section? Financial incentives should not be allowed to sway a doctor's judgment. The judgment should be made solely based on a doctor's years of training and experience.
  • PaigeR
    -- Nonmember comment from

    PaigeR

    July 15, 2012 at 10:23 AM
    I had to have a c-section at 37 weeks 0 days because my water broke and my baby was breech. Apparently, because of the shape of my uterus every time I have a child this will most likely happen. For someone like me, c-section has to be an option. I have heard of people who "request" c-sections in lieu of giving birth vaginally just because they want to...I think this is crazy! I think that is what the insurance companies are trying to get rid of.
  • Mary...
    -- Facebook comment from

    Mary Ward

    July 15, 2012 at 10:55 AM
    The author of this article is doing a disservice by giving the public the perception that doctors are making all this money by performing C-sections. Do your research 1st!!! Hospitals make the bulk of money from C-sections. OB/GYN's are in a difficult position. Everyone one a "perfect" baby and any problems can lead to lawsuits. This is why OB/GYN's malpractice insurance is so high and why many of them can no longer afford to practice obstetrics and are eliminating it from their practice, which is becoming a BIG problem. I think OB/GYN's feel C-section's can be much more controlled with less likelihood of complications. The problem is much more complex than what you've presented and it is unfair to malign physicians. We will all need a physicians at some point in our lives so why contribute the public mistrust of physicians. Many of us have our patients best interest at heart and at times have sacrificed our own wants and needs for the good of our patients.
  • irishk85
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    irishk85

    July 15, 2012 at 10:57 AM
    If I hadn't have had my section at 30 weeks both myself and baby would have died. I don't agree with requesting c sections but I am grateful that medicine has advanced to the point it is my story could have been a very different one. I do agree c sections are being over done though when it comes to the elective ones
  • Karla
    -- Nonmember comment from

    Karla

    July 15, 2012 at 11:00 AM
    EXACTLY what Cass said. My c-section was necessary and life saving for my son who was born at 41w1d. If we give the hospitals and doctors incentive to stop c-sections, what kind of can of worms are we opening for those who NEED them? Why should we make doctors, the health and life saving professionals (as opposed to the insurance companies, the greedy people who think they know it all and can make decisions on life and death) think twice on saving a life because it's not cost effective?
  • jmbunn
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    jmbunn

    July 15, 2012 at 11:01 AM
    If a c-section is 100% without a doubt needed then ok. But as far as doing a c-section for covience then that's bs.
  • NavyWife
    -- Nonmember comment from

    NavyWife

    July 15, 2012 at 11:05 AM
    Well, excuse me for not having a golden uterus and the ability to withstand cramps that feel like there's a vice grip around my pelvis! My c-section was necessary or my son would've probably died. People who request them when they are perfectly capable of delivering vaginally should be smacked. Money shouldn't dictate who gets one and who doesn't
  • SSV2080
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    SSV2080

    July 15, 2012 at 11:11 AM

    The insurance companies are just doing what they do best...take our money and then not want to shell out a cent when what we pay for occurs. Don't even get me started on them, but yes I think it is sick when people have c-sections or get their labor induced just because they are tired of being pregnant or the doctor is going out of town. So far everybody I know personally who has had a c section had to do it as a last resort because something was wrong with the baby, or they were way past their due date and their bodies weren't responding to induction.


  • Sarah
    -- Nonmember comment from

    Sarah

    July 15, 2012 at 11:14 AM
    I'm not sure I completely believe that doctors are raking in all this cash if you have a c-section...
    My first was necessary. My second was because I was given the option of a repeat c-section or a VBAC. I went with the c-section, which will probably be my biggest regret for the rest of my life.
  • ghost...
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    ghostbaby

    July 15, 2012 at 11:23 AM
    I don't think its crazy to request the way you want to give birth. If you want a c-section, then you should get one. Especially when you have the insurance to pay for it. Its not as if its a cosmetic request. Its a choice that should be left to the mother to decide unless there is a problem.
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