Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition

[Modbert]

Think Progress » Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition

Adding to the list that in seven states that being a victim of Domestic Abuse is a pre-existing, now is having a Caesarean-Section Pregnancy.

Why? Anthem Blue Cross — which has been actively fighting health care reform — considers pregnancy optional and therefore not necessary to insure

When a woman isn’t currently pregnant, she often still cannot get coverage. Many insurers consider a Caesarean-section pregnancy a pre-existing condition and refuse to cover women who have had the procedure. From a 2008 New York Times story about a Colorado woman who had Golden Rule Insurance:

The number of C-sections performed in the United States has been “growing steadily,” with approximately 30 percent of women having the procedure. Other insurance companies that don’t necessarily reject women with C-sections often do charge them higher premiums or “factor in chronic or recurring problems that might have led to the Caesarean.” What’s even worse is that once you’re denied by one company, it’s harder to get coverage somewhere else because you’ve been red-flagged.

So to go over the list of what is considered a "pre-existing condition"

1.) Pregnancy
2.) Survivor of Domestic Abuse
3.) Caesarean-Section Pregnancy
4.) Cancer
5.) Diabetes
6.) HIV/AIDS
7.) Depression
8.) Mild Asthma

Feel free to add more that you know of.

Also, on the topic of abused women who are survivors of domestic abuse:

In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed.
All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the "Gang of Six" on the Finance Committee who are hashing out a bipartisan bill.

In 1994, then-Rep. Charles Schumer (D-N.Y.), now a member of Senate leadership, had his staff survey 16 insurance companies. He found that eight would not write health, life or disability policies for women who have been abused. In 1995, the Boston Globe found that Nationwide, Allstate, State Farm, Aetna, Metropolitan Life, The Equitable Companies, First Colony Life, The Prudential and the Principal Financial Group had all either canceled or denied coverage to women who'd been beaten.

So, for all those of you against ALL types of Health Care Reform, and others. Thoughts? Opinions?

 

[Political Junky]

California's Real Death Panels: Insurers Deny 21% of Claims


For Immediate Release
September 2, 2009
Print Text Only
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California's Real Death Panels: Insurers Deny 21% of Claims

PacifiCare's Denials 40%, Cigna’s 33% in First Half of 2009

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care -- 22 percent of all claims.

 

[Modbert]

Health Care Rationing does exist as I just mentioned in another thread. It's amazing how these companies think they can charge so much more and yet cover less. The arrogance on their part.

However, when you have your profits up 428% from 2000 to 2007, it's no wonder why they're doing it.

 

[American Horse]

Think Progress » Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition

"She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."
....<SNIP>
So, for all those of you against ALL types of Health Care Reform, and others. Thoughts? Opinions?

Not quite the same as what the OP implies.
An insurer may - but some won't - make the determination, no doubt statistically, that a female who has had one caesarian section will more than likely fall into that same category during a subsequent pregnancy.

A female purchaser of a health insurance policy will have a harder time finding a policy which will take her on, but by no means is she precouded from finding one, even though she has a recent history. Insurance companies already know that a female of child bearing age will probably have a child, and take those policies on by actuarily calculating the risk; from your post quoted above (bolded) indicates that she still "might have qualified," and that the Golden Rule company takes positive information into account.

Insurance companies aren't providers of health care. But for a monthly premium they take on the obligation to pay for a large percentage of the cost of our healthcare to alleviate the burden of risk of high medical costs. The woman in this case could opt for sterilization, which would eliminate any risk of the need for a caesarian section. That would also probably earn her a lower rate for insurance since she would never again run the risk of becoming pregnant.

And as for your last comment. About everyone, Democrat or Republican, believes our health care system needs reforming. Most of the solutions that have been real solutions have come from the R side, with the Ds holding back any ideas from that side so as to completely re-shape the whole health/medical sector. They have been rabid about it, for instance setting limits on the number of MSAs and HSAs because they will work, find satisfied customers, and add competition - siince people would be spending their own tax credit money to buy it - but also those instruments will undermine their opportunity to do a government take-over of the whole medical field.

Some of what you say, like woman who have a history of being with men who abuse them are going to be risky to insure, either for health and yes even for life insurance, and that suggests the type of help they need.

 

[JW Frogen]

We are only just down from the trees so it comes as no surprise people will kill for money.

The men in ties behind dull desks have no immunity to this compulsion.

In fact it is easier to kill with a stamp that says "denied" than looking a real enemy in the eye.

 

[Modbert]

We are only just down from the trees so it comes as no surprise people will kill for money.

The men in ties behind dull desks have no immunity to this compulsion.

In fact it is easier to kill with a stamp that says "denied" than looking a real enemy in the eye.

Ain't that the truth.

 

[auditor0007]

Think Progress » Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition

Adding to the list that in seven states that being a victim of Domestic Abuse is a pre-existing, now is having a Caesarean-Section Pregnancy.

Why? Anthem Blue Cross — which has been actively fighting health care reform — considers pregnancy optional and therefore not necessary to insure

When a woman isn’t currently pregnant, she often still cannot get coverage. Many insurers consider a Caesarean-section pregnancy a pre-existing condition and refuse to cover women who have had the procedure. From a 2008 New York Times story about a Colorado woman who had Golden Rule Insurance:

The number of C-sections performed in the United States has been “growing steadily,” with approximately 30 percent of women having the procedure. Other insurance companies that don’t necessarily reject women with C-sections often do charge them higher premiums or “factor in chronic or recurring problems that might have led to the Caesarean.” What’s even worse is that once you’re denied by one company, it’s harder to get coverage somewhere else because you’ve been red-flagged.

So to go over the list of what is considered a "pre-existing condition"

1.) Pregnancy
2.) Survivor of Domestic Abuse
3.) Caesarean-Section Pregnancy
4.) Cancer
5.) Diabetes
6.) HIV/AIDS
7.) Depression
8.) Mild Asthma

Feel free to add more that you know of.

Also, on the topic of abused women who are survivors of domestic abuse:

In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed.
All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the "Gang of Six" on the Finance Committee who are hashing out a bipartisan bill.

In 1994, then-Rep. Charles Schumer (D-N.Y.), now a member of Senate leadership, had his staff survey 16 insurance companies. He found that eight would not write health, life or disability policies for women who have been abused. In 1995, the Boston Globe found that Nationwide, Allstate, State Farm, Aetna, Metropolitan Life, The Equitable Companies, First Colony Life, The Prudential and the Principal Financial Group had all either canceled or denied coverage to women who'd been beaten.

So, for all those of you against ALL types of Health Care Reform, and others. Thoughts? Opinions?

They won't consider it a pre-existing condition if she's already had a hyterectomy though. You see, if a woman needs a C-section for one pregnancy, odds are extremely high that any later pregnancies will also require a C-section, and those cost money, so the insurance companies can't possibly take on the risk that she might become pregnant again. Remember something very important; insurance companies aren't here to do us a service; they are here to make money for their stockholders.

Bottom line? Insurance companies and healthcare are a bad mix.

 

[auditor0007]

Health Care Rationing does exist as I just mentioned in another thread. It's amazing how these companies think they can charge so much more and yet cover less. The arrogance on their part.

However, when you have your profits up 428% from 2000 to 2007, it's no wonder why they're doing it.

This is the only thing I don't have a problem with when it comes to insurance companies and healthcare. They really are not making huge profits. Based on sales, their profits are only three to six percent. Unfortunately, insurance companies have created a bigger bureaucracy than the federal government could ever imagine, and this is driving up costs on both sides, from the insurance companies and the providers.

 

[Emma]

So to go over the list of what is considered a "pre-existing condition"

1.) Pregnancy
2.) Survivor of Domestic Abuse
3.) Caesarean-Section Pregnancy
4.) Cancer
5.) Diabetes
6.) HIV/AIDS
7.) Depression
8.) Mild Asthma

Feel free to add more that you know of.

You don't even have to HAVE the 'condition' for it to be considered a pre-existing condition. I was denied private health insurance because of the supposed-pre-existing condition of 'biliary tract / gallbladder disease'. Since I most certainly did not have this, I contacted them to find out how they'd come to that conclusion. Seems they looked at some old hospital records where I was admitted for abdominal pain to rule out gallbladder disease and ran with it. Even though it WAS ruled out, they insisted I did indeed have that pre-existing (NON existent) condition and the denial stood.

 

[code1211]

Health Care Rationing does exist as I just mentioned in another thread. It's amazing how these companies think they can charge so much more and yet cover less. The arrogance on their part.

However, when you have your profits up 428% from 2000 to 2007, it's no wonder why they're doing it.

For the sake of comparison, a listing of the top 52 industries by profit. "Health Care: Insurance and Managed Care" ranks at 28th. "Wholesalers: Health Care" ranks at 47th. The one at 28 has more recognizable names in it.

"Network and other communications equipment" is first and "Homebuilders" is last with a big negative.

"Food Services" is 16th, so, the next time you get a Big Mac, be sure to spit at the counter person when they take your money.

http://money.cnn.com/magazines/fortune/fortune500/2008/performers/industries/profits/

 

[Care4all]

Think Progress » Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition

"She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."
....<SNIP>
So, for all those of you against ALL types of Health Care Reform, and others. Thoughts? Opinions?

Not quite the same as what the OP implies.
An insurer may - but some won't - make the determination, no doubt statistically, that a female who has had one caesarian section will more than likely fall into that same category during a subsequent pregnancy.

A female purchaser of a health insurance policy will have a harder time finding a policy which will take her on, but by no means is she precouded from finding one, even though she has a recent history. Insurance companies already know that a female of child bearing age will probably have a child, and take those policies on by actuarily calculating the risk; from your post quoted above (bolded) indicates that she still "might have qualified," and that the Golden Rule company takes positive information into account.

Insurance companies aren't providers of health care. But for a monthly premium they take on the obligation to pay for a large percentage of the cost of our healthcare to alleviate the burden of risk of high medical costs. The woman in this case could opt for sterilization, which would eliminate any risk of the need for a caesarian section. That would also probably earn her a lower rate for insurance since she would never again run the risk of becoming pregnant.

And as for your last comment. About everyone, Democrat or Republican, believes our health care system needs reforming. Most of the solutions that have been real solutions have come from the R side, with the Ds holding back any ideas from that side so as to completely re-shape the whole health/medical sector. They have been rabid about it, for instance setting limits on the number of MSAs and HSAs because they will work, find satisfied customers, and add competition - siince people would be spending their own tax credit money to buy it - but also those instruments will undermine their opportunity to do a government take-over of the whole medical field.

Some of what you say, like woman who have a history of being with men who abuse them are going to be risky to insure, either for health and yes even for life insurance, and that suggests the type of help they need.

OH MY GOD
I can NOT believe you even SUGGESTED that she get herself sterilized as an option....

 

[Old Rocks]

Think Progress » Health Insurers Consider A Caesarean-Section Pregnancy A Pre-Existing Condition

"She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."
....<SNIP>
So, for all those of you against ALL types of Health Care Reform, and others. Thoughts? Opinions?

Not quite the same as what the OP implies.
An insurer may - but some won't - make the determination, no doubt statistically, that a female who has had one caesarian section will more than likely fall into that same category during a subsequent pregnancy.

A female purchaser of a health insurance policy will have a harder time finding a policy which will take her on, but by no means is she precouded from finding one, even though she has a recent history. Insurance companies already know that a female of child bearing age will probably have a child, and take those policies on by actuarily calculating the risk; from your post quoted above (bolded) indicates that she still "might have qualified," and that the Golden Rule company takes positive information into account.

Insurance companies aren't providers of health care. But for a monthly premium they take on the obligation to pay for a large percentage of the cost of our healthcare to alleviate the burden of risk of high medical costs. The woman in this case could opt for sterilization, which would eliminate any risk of the need for a caesarian section. That would also probably earn her a lower rate for insurance since she would never again run the risk of becoming pregnant.

And as for your last comment. About everyone, Democrat or Republican, believes our health care system needs reforming. Most of the solutions that have been real solutions have come from the R side, with the Ds holding back any ideas from that side so as to completely re-shape the whole health/medical sector. They have been rabid about it, for instance setting limits on the number of MSAs and HSAs because they will work, find satisfied customers, and add competition - siince people would be spending their own tax credit money to buy it - but also those instruments will undermine their opportunity to do a government take-over of the whole medical field.

Some of what you say, like woman who have a history of being with men who abuse them are going to be risky to insure, either for health and yes even for life insurance, and that suggests the type of help they need.

Complete bullshit, Horse. The Repubs have offered nothing but NO.

As of now, I am for ramming whatever we can get through down their throat, then stamping on it a few times to make sure it stays down. We should have gone for a universal system such as Canada's from the git-go. The Repubs can and should go to hell.

 

[Old Rocks]

Health Care Rationing does exist as I just mentioned in another thread. It's amazing how these companies think they can charge so much more and yet cover less. The arrogance on their part.

However, when you have your profits up 428% from 2000 to 2007, it's no wonder why they're doing it.

This is the only thing I don't have a problem with when it comes to insurance companies and healthcare. They really are not making huge profits. Based on sales, their profits are only three to six percent. Unfortunately, insurance companies have created a bigger bureaucracy than the federal government could ever imagine, and this is driving up costs on both sides, from the insurance companies and the providers.

But their upper management really pull down the big bucks!

 

[Old Rocks]

Health Care Rationing does exist as I just mentioned in another thread. It's amazing how these companies think they can charge so much more and yet cover less. The arrogance on their part.

However, when you have your profits up 428% from 2000 to 2007, it's no wonder why they're doing it.

For the sake of comparison, a listing of the top 52 industries by profit. "Health Care: Insurance and Managed Care" ranks at 28th. "Wholesalers: Health Care" ranks at 47th. The one at 28 has more recognizable names in it.

"Network and other communications equipment" is first and "Homebuilders" is last with a big negative.

"Food Services" is 16th, so, the next time you get a Big Mac, be sure to spit at the counter person when they take your money.

Fortune 500 2008: Top Performers - Most Profitable Industries: Return on Revenues

Fine. Then let's put the poor bastards, the Health Care for Profit Capitalist, out of their pain. Eliminate them, and join the rest of the civilized world with a real universal health care system.

 

[Care4all]

more like 6%-8% profit after all salaries, reinvestment, cost of goods, and taxes are paid, i believe...?

not 3%?

 

[American Horse]

The woman in this case could opt for sterilization, which would eliminate any risk of the need for a caesarian section. That would also probably earn her a lower rate for insurance since she would never again run the risk of becoming pregnant.
...<SNIP>

Some of what you say, like woman who have a history of being with men who abuse them are going to be risky to insure, either for health and yes even for life insurance, and that suggests the type of help they need.

OH MY GOD
I can NOT believe you even SUGGESTED that she get herself sterilized as an option....

Care ... I've known women to have their "tubes tied" just to prevent any future pregnancies - another less inflamatory phrase for STERILIZATON; hopefully it was that word that caused your "eeeks." - Or for reasons far less consequential than the risks of undergoing a C-section. I would think the risk of complications of a subsequent C-section pregnancy might be a motivator, being a matter of their health/medical/safety.

Those women who would not choose not to play it safe with that option, plan to still bear a child, and have found themselves completely without any options for insurance can get it from a state assigned risk pool (I have some dollar figures below) or she can double down to find insurance, even to exploring the possibility of going to work for a company with a group plan where "so called pre-existing" conditons are absorbed as a matter of course.

For a 35 - 39 year old female with pre-existing condtions under the Indiana Assigned risk pool the premium would be $502/month for a 1,000 deductible. and $468/1,500 ded. Any difference between these premiums and any other state would be because of mandates and regulations differing from Indiana's. The assigned risk pool is created by the state to require any insurance company writing health insurance policies in the state to accept on a rotating basis people who are uninsurable due to pre-exising health conditions or orphan diseases.

 

[SmarterThanHick]

Add acne to the list too, per Obama's example in his recent speech.

You see, if a woman needs a C-section for one pregnancy, odds are extremely high that any later pregnancies will also require a C-section, and those cost money, so the insurance companies can't possibly take on the risk that she might become pregnant again. Remember something very important; insurance companies aren't here to do us a service; they are here to make money for their stockholders.

Bottom line? Insurance companies and healthcare are a bad mix.

You're right about the money making part, but where are you getting your medical knowledge?

Fine. Then let's put the poor bastards, the Health Care for Profit Capitalist, out of their pain. Eliminate them, and join the rest of the civilized world with a real universal health care system.

We don't even need that. Japan doesn't have universal healthcare, and they're at the top of the charts with health outcomes at about half the cost the US is currently spending.

 

[Care4all]

The woman in this case could opt for sterilization, which would eliminate any risk of the need for a caesarian section. That would also probably earn her a lower rate for insurance since she would never again run the risk of becoming pregnant.
...<SNIP>

Some of what you say, like woman who have a history of being with men who abuse them are going to be risky to insure, either for health and yes even for life insurance, and that suggests the type of help they need.

OH MY GOD
I can NOT believe you even SUGGESTED that she get herself sterilized as an option....

Care ... I've known women to have their "tubes tied" just to prevent any future pregnancies - another less inflamatory phrase for STERILIZATON; hopefully it was that word that caused your "eeeks." - Or for reasons far less consequential than the risks of undergoing a C-section. I would think the risk of complications of a subsequent C-section pregnancy might be a motivator, being a matter of their health/medical/safety.

Those women who would not choose not to play it safe with that option, plan to still bear a child, and have found themselves completely without any options for insurance can get it from a state assigned risk pool (I have some dollar figures below) or she can double down to find insurance, even to exploring the possibility of going to work for a company with a group plan where "so called pre-existing" conditons are absorbed as a matter of course.

For a 35 - 39 year old female with pre-existing condtions under the Indiana Assigned risk pool the premium would be $502/month for a 1,000 deductible. and $468/1,500 ded. Any difference between these premiums and any other state would be because of mandates and regulations differing from Indiana's. The assigned risk pool is created by the state to require any insurance company writing health insurance policies in the state to accept on a rotating basis people who are uninsurable due to pre-exising health conditions or orphan diseases.

no, c-sections actually save lives from complicated pregnancies for a number of reasons...and also, doctors are less likely to deliver a damaged baby, so some doctors jump at the chance of a c-section if given to them, over normal labor delivery....less malpractice suits with c-sections.

once a doctor gives you a c-section, all other deliveries of yours will be c-sections, bar a miracle....but so what? it is actually a SAFER delivery than going through the hours and sometimes days of labor and delivery????

the insurance companies are just making up an excuse just to NOT COVER PEOPLE, to be able to charge them a heck of alot more.

saying sterilization is an answer is just silly mustang because this woman may not want children now, or for a few more years, but then 5 years from now decide to have a child...is she really uninsurable during that time?

sheesh all men who have not been FIXED like a dog should go and get nipped or else their insurance should cost more because of their preexisting condition of being able to make another woman pregnant that this insurance company may carry a policy on.....how's that?



care