Help me help my cousin get a VBAC!

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AnnaRO's picture
Joined: 07/06/08
Posts: 7033
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!

alwayssmile's picture
Joined: 08/26/07
Posts: 14483

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.

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

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.

momW's picture
Joined: 09/29/09
Posts: 5634

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.

Spacers's picture
Joined: 12/29/03
Posts: 4099

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.

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

She lives in Minneola, KS. I'm waiting to hear back from her on her insurance carrier.

momW's picture
Joined: 09/29/09
Posts: 5634

"Spacers" wrote:

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.

Joined: 05/15/08
Posts: 413

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.

Spacers's picture
Joined: 12/29/03
Posts: 4099

"AnnaRO" wrote:

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.

Joined: 04/30/09
Posts: 2257

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.

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

I haven't heard back yet on who her insurance carrier is, but she said that since she went early with her son (37 weeks), and that the c/s wouldn't be 'scheduled' until around 39 weeks she's hoping that she goes early again and then she can wait it out at home until it's too late for a c/s.

In the interest of full disclosure: She was diagnosed with 'small uterus' (apparently super tiny) after her son was born and he has Down's. I don't know if her uterus size has anything to do with the D.S., but I know she had some sort of surgery back in March to correct something with either her cervix or uterus, and she was told it was unlikely she'd have more children. She was devastated thinking she'd only have one child, but now she's pg (12 weeks). My point with all this is, that she may not be considered low risk, depending on what her medical record actually indicate. Anyway, I sent her a long email telling her that she needs to call them again and again until she talks to someone important enough to help her. I understand if there are circumstances in the end that don't allow her to have a VBAC, but every woman who wants one should at least be allowed to try.

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

Her uterus size has nothing to do with Downs. Its a chromosomal abnormality.

Even with her history, it should be up to the OB not the insurance company to tell her what her options are. With her history, it might be unlikely that a birth center will take her. Sad

alwayssmile's picture
Joined: 08/26/07
Posts: 14483

My thoughts were that she might be risked out of HB and birth centers. Sad However, if I were her I'd fight the no VBAC if it was a battle I believed strongly in (I do, but she may not). Now more than ever she needs a doctor to talk with and get straight answers from. Sadly, those aren't always very easy to find.

Spacers's picture
Joined: 12/29/03
Posts: 4099

"AnnaRO" wrote:

I know she had some sort of surgery back in March to correct something with either her cervix or uterus, and she was told it was unlikely she'd have more children. She was devastated thinking she'd only have one child, but now she's pg (12 weeks).

Unless it was a very minor procedure, she's probably going to be told that she's risked out of VBAC; anything invasive, from surgery in March to pregnancy in July is simply not enough healing time by VBAC standards. If it were me, and if I made it to term, I'd still insist on a trial of labor, because I believe babies should choose their own birthdays and that labor is good for a baby, but I wouldn't stay home during labor. I would labor very close to the hospital, if not in the hospital (you can walk the hallways without being admitted, hang out in the chapel, etc.) and pay close attention to my body & baby, and not second-guess any kind of warning sign. Wishing her all the best!

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