Had a C-section? Good Luck Getting Health Insurance…

by Lisa Codispoti, Senior Advisor
National Women’s Law Center

This post is part of a weekly series on Women and Health Reform.

This past weekend, a New York Times story provided a frightening lesson about the individual insurance market. Most of us get health insurance through our job, but those who aren’t so lucky and don’t qualify for public coverage are often left with little choice other than buying insurance directly from an insurance company – this is known as the “individual market.” 

If you’re unfamiliar with the individual market, I call it the “wild, wild west” of health insurance. It’s a place where insurance companies have complete and total power - subject only to a set of skimpy regulations in most states. In the individual market, it is generally legal for an insurance company to deny coverage to someone with a pre-existing health condition (such as a history of cancer, depression, asthma, or even hayfever) or to sell them a stripped-down policy that doesn’t cover the condition. Alternatively, an insurer might just charge someone with a pre-existing condition more for their health insurance. They may also be allowed to charge more depending on a person’s gender, age, or occupation. (Gender you say? Yep, in 40 states and the District of Columbia, it is legal for insurers to charge women and men different rates for the exact same health insurance policy). Only a few states have outlawed such practices.

The Times story this weekend reported on otherwise healthy women with previous Cesarean sections who are denied health insurance when they apply for coverage in the individual market (unless they are beyond their reproductive years or have proof of sterilization, that is). The insurance companies’ rationale?  Well, women with a previous C-section are more likely to have another C-section, and insurers just don’t want to take on that financial risk. It’s yet another reason that we need comprehensive health reform. Let’s not leave women who aren’t lucky enough to have job-based coverage at the mercy of the health insurance industry, all alone in the wild, wild, west.

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[jamie]

your article is me!!!! I can't get a company to cover me for a c-section They will cover the pregnancy just not the c-section or anything coded in concetion with a csection I had to sign a permanent exclusion if I wanted coverage. I have tried everything and every company and I simply cant get covered unless I part of a group poliy I DONT KNOW WHAT TO DO