Healthcare provider says it will fund caesarean sections for medical reasons
BUPA has spoken out against AXA PPP healthcare's decision to stop providing cover for caesarean sections in its private medical insurance (PMI) policies.
The provider has said it will continue to fund all caesarean sections carried out for medical reasons, adding it has no plans to emulate its closest rival.
AXA blamed the removal of the benefit on an increase in elective caesarean sections.
However, Dr Natalie-Jane Macdonald, medical director of BUPA, remained adamant it could successfully continue to provide caesarean section cover for its members.
'We believe we can work with our doctors and consultants closely in order to determine those who need the operation for medical reasons and those who elect to have the procedure,' she said.
Macdonald added BUPA would continue to audit individual cases to determine the necessity of every caesarean section procedure and stressed the situation can be successfully controlled and monitored.
'Cover for caesarean section is an important benefit to a number of our policyholders and we have no plans to change it,' she said.
Around 50% of deliveries in private hospitals are carried out by caesarean section, and the boundary between medical emergency and elective caesareans is becoming increasingly blurred.
Dr Adrian Bull, medical director of AXA PPP healthcare, said: 'We have decided to stop paying for caesarean sections on our medical insurance policies. It was becoming increasingly difficult for us to distinguish between medically necessary caesarean sections and caesarean sections that are a personal or lifestyle choice.'
'Caesarean sections are be-coming more a matter of choice rather than a risk, and insurers can only cover risk,' he concluded.
Still at an early stage, it is difficult to tell whether AXA's decision will influence consumers' choice of PMI provider.
Hazel Gregory, managing director at Medical Insurance Services, does not believe the insurer will lose out and said she feels AXA has made the correct decision. 'If an insurer has difficulty in identifying whether caesarean section claims are elective or for medical necessity, there are two routes. Either the premiums increase to cover the cost of claims, or the cover is reviewed and changed accordingly,' she said.
Gregory added that while it is evident many caesarean sections are required for medical reasons, PMI is not intended to cover elective procedures.
'There is not a premium charged to cater for that option. It has been designed to cover specific obstetric procedures. AXA's decision to withdraw their cover shows this factor is clearly a problem,' she said.
