Maternity Coverage

Unfortunately, exclusion or denial of coverage for previous cesarean sections is legal in most states (maybe even all states). See this article in the Times http://www.nytimes.com/2008/06/01/health/01insure.html

As soon as I saw this new trend in the insurance industry, I sent off a blistering letter to the chair of the OB/GYN department at UIC Medical Center. Moms are left in a catch-22 situation when it comes to c-sections. OBs have incentive to perform them and avoid any unfavorable outcomes and potential malpractice suits. But, VBAC bans have been growing thanks to ACOG and now many women who want to have a VBAC are not allowed.

Clearly, many OBs aren't even considering this much longer-lasting implication of doing any c-section. The topic of potential future denial of health insurance coverage in the individual market certainly didn't come up in my "informed" (or was it "uninformed") consent discussion with my OB before the c-section for breech position.

Even though it seems wrong, it is legal to exclude c-sections.

Here is the website for Illinois state coverage, you can determine if you qualify.

http://covertheuninsured.org/stateguides/english/IL.pdf

Good luck.

Unfotunately they can exclude anything they want. I would certainly contact them and go up the ladder, reminding them that you have had their ins for sometime! You may try United Healthcare, Humana or Celtic Ins!. Your best bet is to contact an insurance broker. They will find a policy that will allow for a c-section, if necessary. Brokers do all the work for you and the insurance companies pay them for signing up a policy, not you.

I run an insuance billing service that offers individuals assistance with their medical claims. If I can be of any further help please contact me and I'll see what I can do for you.
Barb R.

It is pretty outrageous and you should send info to the Division of Insurance at the State of Illinois. Depending on your income, you might qualify for the States Moms and Babies program. If you go to www.health.illinois.gov it has info on all the state programs. There is one for pregnant women. There is also a family coverage program called familycare.
You should also contact your state legislators as they are considering insurance reform that would include a program that would prohibit this kind of discrimination. Rep. Greg Harris is going to introduce a bill but you might suggest to your legislator that they introduce a bill to require insurers in Illinois to provide full maternity coverage as part of the basic benefit.

If you live in Illinois you should apply for the state insurance. Me and my two children were on the insurance and I only paid $30 a month. After I reapplied, I was told that I could no longer be covered, but my kids still were. I decided to keep my children on the state insurance, and get insurance for myself through my job. I pay $25 a month for both my kids. It is much less expensive than adding them onto my policy at work, and fortunately my children do not have any medical issues, so I really only need to take them to the doctor when they are sick and for check-ups. Unfortunately, I do not know the specifics of the coverage for pregnancy, but I believe it would cover anything that is necessary. Go to the Illinois Department of Human Services website to find out more info.

A friend of mine who was self-insured didn't get the maternity coverage and told us that if she had to have a C-section it would be covered as part of her own health insurance, and if the baby was a preemie, that would be covered under the baby's insurance on the policy. So the maternity coverage would have covered the OB bill for the visits and the hospital stay. (they ended up pre-paying under a payment plan with the hospital, and she did have a c-section.)

I don't know anything about it from experience, but it seems like it would be worth a call to BCBS to make sure you understand it. My friend was covered under a policy from an association her husband belongs to (for graphic artists, I think.)

Same situation with me. Had my son, vaginal birth, with group insurance. After having my daughter c-section, I had to get indiv. medical insurance, because I was no longer working. BCBS put a rider on my insurance that they would not cover c-section. If I were you, I would get on state insurance if possible before you even get pregnant or get a job (home depot part time gives group medical coverage-example). I have 2 kids, and wanted a third, but unless I get group health insurance, I am not taking any risks. My husband is also self employeed and I have looked for cost effective health insurance for us for the last 10 years, to sum it up....there is no alternative, unless you go on state aide or get a job with group insurance, or pay out the nose in sky rocketing indiv. health insurance. If you find an alternative, please let me know. Best of Luck!!