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Re: cesarean on demandFrom: D. Ashley Hill (dahmd@cfl.rr.com)Fri Dec 30 20:05:13 2005
Anna has a good point: it's not our job to lie to insurers to obtain coverage for patients. FWIW, here is how I handle patients who request "on demand" c/sections, which have become a hot topic in our area: 1. Long discussion of risks and benefits, with disclosure that long-term studies comparing methods of delivery are lacking. I explore the patient's reasons for wanting an elective cesarean and have noted that the most common reason is fear of future incontinence or prolapse, and the second most common reason is for scheduling convenience. (Some anti-cesarean lobbyists have suggested that patients are in fear of labor pain, but NO patient has ever told me that she prefers post-operative pain over labor pain, and, anyway, about 80% of the patients in our area get epidurals). 2. If the patient still wants a truly elective cesarean (most change their minds after my risk/benefit discussion) then I will do it at 39 weeks, but I won't do an amnio prior to 39 weeks so the patient can have her elective cesarean sooner. 3. I advise that she contact her insurer to check payment status, and explain that if they refuse payment, my employer (a hospital) likely will go after her for payment, which may damage her credit. 4. To my knowledge no insurer has refused payment for an "on demand" cesarean in our area. I suspect they don't look that closely, perhaps because almost 30% of US births are now by cesarean. Happy New Year, everyone. Ashley
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency and Loch Haven Ob/Gyn Group Orlando, Florida
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