Punishing the pregnant - Health insurance providers forcing expectant mothers to pay upfront and claim refunds

Local health insurance providers are coming under pressure from some women's rights advocates who are angry over the provision that pregnant women will have to pay upfront for medical services and then claim a refund.

Despite having health insurance, the pregnant women are required to pay for prenatal care, lab tests, ultrasounds, hospital fees, the delivery of their babies, and in some cases their prescriptions, then submit a claim form to the insurance company for a refund.

But gender specialist Nadeen Spence says the health and well-being of pregnant women and their babies are being compromised by the provision.

"It sounds like they are preying on women's vulnerability in pregnancy and their need for healthcare," said Spence after it was pointed out that some medical providers do not provide the pregnant women with the forms to claim their refund.

At 33 weeks pregnant, Tricia Campbell* is adamant that having to pay the full cost for medical services and then submitting a claim to her health insurance provider is "grossly unfair".

According to Campbell, every medical facility she has visited so far has refused to accept her health card upfront, although both she and her husband are making a monthly contribution to their health plan through their respective employers.

"If I don't have to claim back for the flu, why do I have to claim back for being pregnant? I already have things that I have to prepare for, like getting my child's things ready," said Campbell, who is expecting her first child in a matter of weeks.

She noted that while those women who seek prenatal care in the public-health system do not have to make any payment, others who opt for private care are being punished.

"You have the minister of health and others telling you that once you are pregnant, you should go for your monthly check-up, because you need to see and understand what is going on with your body. You need to understand what could possibly go wrong with your child, because it is a process," said Campbell.

She noted that for a condition which she could have used her health card and paid a fraction of the cost before she was pregnant, she now has to pay the full amount and make a claim just because she is carrying a child.

"You are basically being set apart, and the only reason you are set apart is because you are pregnant, and that is the basis for gender bias, that is the basis for gender discrimination," charged Campbell.

Lola Beckford* had similar challenges before giving birth to her third child in January.

She told The Sunday Gleaner that the provision that she can claim back the money spent to receive treatment is of little comfort as she was refunded a measly sum by her health insurance provider when she had her first baby eight years ago.

"All I got was $4,000 and I was so upset," said Beckford.

Last week, gynaecologist/ obstetrician Dr Charles Rockhead urged pregnant women not to blame the medical providers.

"We don't have a choice. We are just doing what we are instructed to do by the insurance company," said Rockhead.

"Once you go to the doctor and you are deemed to be pregnant, we have to make you pay upfront and we give you a claim form that is now sent by the patient to the insurance company. If we bill it as a routine consultation and they find out, we have to pay back that money to the insurance company," said Rockhead, as he added that he would like to see health insurance providers covering the true cost of a pregnancy.

According to Rockhead, this would be a change that women would have to lobby for.

A Sunday Gleaner check showed women paying as much as $100,000 or more for prenatal care, ultrasounds, lab tests and delivery combined in the private health sector.

"I don't think enough is being invested into women's healthcare, in particular maternity healthcare in the private sector," said Rockhead.

He added: "It would, therefore, be incumbent on the insured, which is mostly women, to stake a claim for greater coverage for maternity benefits. That is what they should be negotiating for themselves, or through their companies or through their unions."

A promised response from one of the country's largest health insurance providers, Sagicor, was not received up to press time, while a customer service representative at MedeCus Health, which is offered by the Guardian Group, said while she could confirm the company's position she could not say why this is the case.

"You can't swipe for pregnancy claim, it is done on a reimbursement basis. So most times, you have to pay and then claim back because it is not a 'swipeable' transaction," she said.

* Names changed on request.

nadine.wilson@gleanerjm.com