Help me help my cousin get a VBAC!
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    Community Host AnnaRO's Avatar
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    Default Help me help my cousin get a VBAC!

    I have a cousin (in Kansas) who's been emailing me because she is pg with her second and desperately wants a VBAC. She got a referral from her primary OB (who apparently doesn't do them) to a VBAC friendly OB 1.5 hours away. Okay. Fine. She was willing to do that to get the birth she wants. So she goes to see this new OB and then finds out that her INSURANCE will not allow her to VBAC! W.T.F.?! It would be more cost effective for them and less risky for her is she has a VBAC and they will NOT ALLOW IT!?

    Is there anything she can do, besides pay out of pocket for the birth (not an option for her)? I am so livid over this!
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    Posting Addict alwayssmile's Avatar
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    Huh? Seriously? Why do they care? She needs to make lots of calls to them and not just take what they first tell as word. Not uncommon from what I've heard to have someone claim falsities on the phone instead of just admitting that they don't know. What insurance does she have? If no one here has an answer or help I'd ask on BWF on FB. It has a big enough following that someone on there might have something.

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    Posting Addict TiggersMommy's Avatar
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    Really? That sounds really odd to me. I've never heard of insurance companies refusing to cover a vaginal birth. Perhaps they won't cover that particular doctor because he's out of network? That seems more likely. If that's the case, have her look for doctors in her network that are VBAC friendly.
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    Posting Addict momW's Avatar
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    Yes, it does happen sadly. However, the thing about insurance companies is you can fight them and win a lot of the times. It doesn't usually take much either just some very consistent pestering with some very good data and numbers. Play their game, give the prices for a vaginal birth versus a c/s. Give them statistics for c/s complications, spelled out very clear. Also make sure they know that they do NOT have the right to put her in harms way with a scheduled c/s. Talk lawyers, human rights and litigation. It really doesn't ever take that much though. If after a couple calls to them (never talk to the first person you get, always go higher up with problems like this) it doesn't help, go to the employer and take the pricing, stats and talk about litigation to them, they do have pull with the people that provide the insurance.

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    Posting Addict Spacers's Avatar
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    If the insurance covers birth, they have to cover vaginal birth, period. I don't think an insurance company that covers birth could legally get away with not covering VBAC. They can refuse to cover a doctor who is out-of-network (unless she has OON coverage for a higher copay), they can refuse to cover a hospital that is out-of-network, and the doctor's liability insurance might refuse to cover VBAC (and that's easily work-around-ed by signing a liability waiver) but those are the only ways that a VBAC might not be covered. The only other thing I can think of is if her insurance doesn't cover maternity care at all, not just VBAC. I actually did some research on VBAC in Kansas for someone a couple of years ago; if you PM me her location & insurance information, I can check my records at home later.
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    Community Host AnnaRO's Avatar
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    She lives in Minneola, KS. I'm waiting to hear back from her on her insurance carrier.

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    Posting Addict momW's Avatar
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    Quote Originally Posted by Spacers View Post
    If the insurance covers birth, they have to cover vaginal birth, period. I don't think an insurance company that covers birth could legally get away with not covering VBAC. They can refuse to cover a doctor who is out-of-network (unless she has OON coverage for a higher copay), they can refuse to cover a hospital that is out-of-network, and the doctor's liability insurance might refuse to cover VBAC (and that's easily work-around-ed by signing a liability waiver) but those are the only ways that a VBAC might not be covered. The only other thing I can think of is if her insurance doesn't cover maternity care at all, not just VBAC. I actually did some research on VBAC in Kansas for someone a couple of years ago; if you PM me her location & insurance information, I can check my records at home later.
    There have been several moms in ICAN groups across the country that have run into insurance companies not wanting to cover VBACs. Most of them were successful getting insurance to cover eventually. I don't know the specifics on why the insurance companies thought they could do that. It really seems like a DUH kind of thing to me. You can't tell a woman HOW she gives birth even if you're an OB, you dam@ sure can't do it if you're just the insurance company but they were trying.

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    In general, insurance companies do not like dealing with birth, because it isn't predictable, on a timetable, and scheduled. The insurance ideal would be for every woman to have a scheduled C. That's why doctors can be so hung up on EDD, their insurance breathes down their neck about it. And I'm not at all surprised that her insurance is being a pain about this, because I was once denied coverage because I had irregular periods. When I asked what I could do to get them to cover me, they told me to get a hysterectomy!

    Anyway, she needs to go over her plan, preferably with an agent looking over her shoulder, to make sure the company is not violating the contract. If her plan does not allow them to refuse a VBAC, then her agent can help her file a complaint and an appeal. If it does allow them to refuse, then she's stuck paying out of pocket. In that case, she's probably better off looking for a birth center that will let her have a VBAC. Insurance usual doesn't do much for midwife-attended, non-hospital births, anyway, but such a birth would be considerably less expensive than a hospital birth.

    If she can and does go in the direction of a birth center, some states require a mw birth to be backed up by an OB, so she might want to ask the VBAC-friendly OB if he/she would be willing to back up the mw if her state requires that.
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    Posting Addict Spacers's Avatar
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    Quote Originally Posted by AnnaRO View Post
    She lives in Minneola, KS. I'm waiting to hear back from her on her insurance carrier.
    Funny, the mom I was helping back then was in Dodge City! While Western Plains hospital does have an official ban on VBACs, they've actually done seven of them in each of the past two years according to the Kansas birth statistics website. Here's the link, you can query any county for any year back to 1990. KIC - Kansas Information for Communities

    IIRC, Southwest Medical Center in Liberal is going to be her best bet if she doesn't want to have to fight too much. They only have two OBs with privileges, but both of them do VBACs.
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    This is so shocking to me. I understand network restrictions and all of that but it amazes me how many hospitals won't even think of VBACs. So glad you had this info available Spacers!

    Anna - I hope your cousin is able to get a plan in order so that she can get her VBAC in a supportive environment that is covered by her insurance.
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