MANAGED CARE July 2007. ©MediMedia USA
A report issued by the Kaiser Family Foundation evaluates the level of insurance protection that consumer-directed health plans (CDHPs) provide women for maternity care. The study provides an estimate of maternity costs under three different clinical scenarios — an uncomplicated vaginal delivery, an uncomplicated Cesarean delivery, and a pregnancy with considerable complications — and compares the level of coverage offered by one traditional insurer and 12 CDHPs in the group and individual markets.
"Childbirth is the most common reason for hospitalization in the United States," says Alina Salganicoff, PhD, vice president and director of Women's Health Policy at Kaiser Family Foundation. "You could have a healthy, young woman who has a very complicated and costly childbirth experience. The cost, in this example, would be difficult to predict."
According to the report, members could be left with thousands of dollars of expenses from maternity care even with an uncomplicated birth, resulting from the high deductibles and cost-sharing requirements of these CDHPs. This can be attributed to the variation in the deductibles, cost sharing requirements, and out-of-pocket maximums among CDHPs.
And while CDHPs often exempt preventive services from the deductible or copayments, all 12 of the CDHPs reviewed did not consider prenatal care a preventive service. "Many of the plans say that they exclude preventive care from the deductible, but prenatal care was not considered a preventive service, which was a surprising finding to us," says Salganicoff.