Does your health care coverage pay for a nutritionist if you're a cancer patient or pregnant ?

October 16, 5:33 PMSacramento Nutrition ExaminerAnne Hart

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If you're a cancer patient, pregnant, need a nutritionist for your genetic or autoimmune problem, or are any other type of patient, how do you find out whether your insurance coverage will pay for a nutritionist to help you plan a special diet?

Will your insurance company pay for a nutritionist if you're pregnant and need a special diet, say, if temporary gestational diabetes or hypertension develops during pregnancy? What if you need a C-section and want to ask a nutritionist what to eat for how many weeks so the stitches don't open when you have a BM?

Or if you need a metabolic and genetic registered dietitian, who pays for it, your insurer or you-- out of pocket? The hospital should have a nutritionist that would help you with your meal selections as part of the cancer treatment They usually have booklets that you follow. What if you have other health problems and need special diet counseling from a nutritionist, for example a specially tailored diet for your diabetes and other health concerns?

First check your individual coverage to see whether nutritionists or registered dietitians are covered. The registered dietitian may work for a hospital, but a nutritionist could be someone who is an entrepreneur. Some chiropractors call themselves nutritionists. Other nutritional counselors are not licensed dietitians and may not have the undergraduate biochemistry background that registered dietitians have. Other types of nutritionists work with vegetarian diets under the supervision of naturopaths and homeopaths. Still other types of nutritionists practice as holistic health counselors, and some aren't licensed.

That's why you need to logon to your local health insurer. Check the back of your insurance card.  Use the Internet to find your own health insurance company online.

At the site of your individual health insurer, you'll probably be able to find a link to access your own account information and coverage online with your member id and social security number.

Review your past paid or pending claims and your co-pays. Then phone the toll-free number on the back of your insurance card to ask a representative or a nurse in utilization management. That way, you can find out how much coverage you have for a nutritionist.

You'll have to ask whether you insurance only covers a hospital-employed registered dietitian such as a metabolic or genetic dietitian who is licensed and has a graduate degree in metabolic and genetic dietetics or whether your coverage includes nutrition counseling from a naturopath or vegetarian dietitian, or any nutritionist of your choice, provided that the person is officially certified.

The problem with some nutritionists is that many states don't require a license. In California, anyone can set himself up to talk to clients about nutrition. You have chiropractors, holistic health workers with two-years of training, former cooks that worked as personal chefs preparing macrobiotic meals, health food store employees with a knowledge of diet and vitamins, students, homeopaths, naturopaths, nurse practitioners, a wide variety of healthcare personnel, registered dietitians, and of course, medical doctors all giving advice to people on nutrition. Then you have the vegetarian clubs, raw food groups, and others talking to people without actually treating anyone, but giving advice about where to find more information on foods.

It boils down to almost anyone with any background, training, or none being able to call himself/herself a nutritional researcher, nutritional journalist, or medical writer. Some nutrition-oriented holistic health advisors call themselves light workers. And usually, none of these people would be covered by insurance policies except a registered dietitian employed by a hospital. But then again, check your individual insurer, as alternative health might be covered by your insurer. Also, some HMOs have alternative health departments. They might employ nutritionists or refer you to nutritionists or even acupuncture professionals certified by your state.

For example, at Kaiser, there's a nutrition department you can call to ask questions or have your doctor refer you for nutritional counseling. Kaiser also has referrals for acupuncture. So alternative or integrated medicine is possible. Talk it over with your insurer and any nutritionist you can consult for information.

Besides finding out whether your health care insurers cover registered dietitians and other nutrition counseling for health problems, having a baby puts you at risk of losing your insurance coverage based on the kind of delivery you had. Not only would some insurers balk at paying for you to talk with a nutritionist on the staff of a hospital or privately as an entrepreneurial registered dietitian specializing in your health problem, but if you had a C-section you could lose your insurance coverage if you don't agree to be sterilized.

Is it all about limiting women to an ideal of two children per family again (like it was in 1965) to reach zero population growth and simply replace husband and wife in the next generation as far as population growth? Or is it really about insurers saving money by taking less risk with patients that have had a C-Section--at the cost of the childbearing-age patient? Follow the money. What happens is that which poses the least financial risk to the insurer.

Interestingly, Congress has been listening to women testify that they have had C-sections and have been denied health insurance because they will not undergo sterilizations. See the article, "After Caesareans, Some See Higher Insurance Cost - NYTimes.com." See the uTube video, "Peggy Robertson tells her story of insurance denial."

According to the NY Times article, "Some insurance companies exempt women from raising the rates of insurance if they get sterilized." The reason why is that it cost more to have a Caesarean section (C-Section) than to have a natural birth. There's the added risk that the scar from the former C-section in the uterus might open up during labor or birth.
Recently, Sen. Barbara Mikulski (D-MD) thought it morally repugnant and offensive that some private insurers would demand sterilization of females that had applied for individual health insurance, according to the Oct. 16, 2009 Examiner.com article, "Women Told to Get Sterilized or No Health Insurance. Also see the McClatchy media article, "Health insurance company won't sell woman coverage unless she gets herself sterilized."

Mikulski is a senior member of the Health, Education, Labor and Pensions (HELP) Committee which produced one of the major health care reform bills. Why should some middle-class women or any woman of any class be told to get sterilized in order to get health insurance coverage? And why should coverage be denied for healthy women just for having a baby?

Is it the old line now applied to humans that veterinarians tell dog-handlers, "If you can't afford the healthcare for your dog, don't get a dog?" To put it lightly, the Senator wasn't amused by the idea of some insurers denying health care coverage for childbearing. For us consumers, the thought is, in the future, will all insurers take this attitude?

Insurer's rules on prior C-sections vary with each company and by state, because the various states regulate insurers. There are 160 million Americans that have health insurance plans through their employers or their spouse's employers. But as more people become self-employed, take jobs without health insurance, work part time, return to college, or lose their jobs, the need for individual insurance policies will be increasing in the foreseeable future.

It's going to be tough for women that have to get health insurance on their own without an employer's financial help. If you're denied health insurance because you refuse to get sterilized after your last C-section where can you turn for help? First you need to find out whether your state offers health insurance coverage to people denied health insurance by private insurers. Premiums on state-offered health insurance could be higher, sometimes 25 percent higher than private insurance, in some cases. But each state is different.

But if you're a woman denied private insurance because you previously had a C-section, you can find out whether your state offers insurance and how much it costs. Some private insurance companies that used to exclude C-sections now cover them, but are charging you an increase in costs as you pay your premiums. Can you afford the increase?

In order to get health insurance, some women are getting sterilized--having their tubes tied for the purpose of removing the insurance risk. In some cases women that had been denied health insurance previously are getting health insurance once they get sterilized. But the ethical question remains, why should you have to tie your tubes in order to get health coverage? Insurers look at the sterilization as removing the risk of further C-sections or the risk of having a natural birth with the added risk of a ruptured uterus as a complication from a previous C-section.

Other insurers want women to wait five years after a pregnancy without a complication if they've had a previous C-section in order to get coverage and remove the risk. What angers a lot of women is that they wonder why some insurers tell them to get sterilized in order to get covered by health insurance. A C-section is not really a pre-existing condition, but some insurers use the fact that a pre-existing condition might have led to the first C-section, such as getting diabetes while pregnant or high blood pressure.

Insurers also sometimes worry that doctors are scheduling C-sections when it's convenient for them or to avoid a long labor if a woman asks for a C-section to avoid labor. Another big worry for the women is the problem that once you're denied insurance, who else is going to give you insurance? For further information, see the June 1, 2008, NY Times article, "After Caesareans, Some See Higher Insurance Costs."

Also see this more recent article, " Women told to 'get sterilized' or no health insurance‎," October 16, 2009. Isn't it amazing that Congress just learned that women who have had Caesarean sections have been denied health insurance unless they agree to sterilization? This problem has been going on for a long time before it even reached Congress. Of interest also is the article, "Discrimination Against Middle Class American Women « The Urban Grind."

Let's say you're in perfect health. You have a C-section. You're then denied health insurance unless you get sterilized or pay much higher premiums because of the risk of what might happen if you get pregnant again.

It's the middle-class mom told to get sterilized or lose health insurance, or find state insurance if it exists, or find individual insurance and pay enormous premiums she can't afford now that she has a newborn to care for at home. If you're a woman who doesn't want to pay to put your infant in daycare so you can work to pay for your premiums you can't get from employers, what can you do?

It's not the poor woman on Medicaid that's being denied. It's the middle-class mom, and no one has brought this to the attention of Congress until now. See the article, "Being denied health insurance coverage for maternity care." Also see the articles, "Insurance Companies: Get Sterilized and Then We'll Cover You," and the article, "Another reason to avoid a C-section « Woman to Woman Childbirth." Also see: "Info On C-Sections - NYC Doula Service." Insurance companies want you to get sterilized if you're going to have repeat C-sections like a lot of the celebrities you read about in the media.

According to a May 27, 2009 Reuters Health report, " Full-term neonates delivered through elective repeat cesarean have higher rates of respiratory morbidity, hypoglycemia, and admission to a neonatal intensive care unit (NICU) than infants delivered by vaginal birth after a previous caesarean, investigators in Denver report in the June issue of Obstetrics & Gynecology." That's one of the reasons why you could be dropped from health coverage or asked to be sterilized, or in some cases, pay a lot higher premiums.

If that's what is happening to middle-class women with incomes or spouses with incomes, think what will be happening to poor women on Medicaid in the near future. What do you think is a solution to this risk situation? Should people go back to zero population growth as it per the 1965 media (two children to replace you and spouse) or find out whether your state will give you health coverage if you're denied by private insurers? Or find a private insurer who doesn't exclude C-sections that you didn't plan to have just for time convenience--that you really needed?

For further information, see the HELP Committee site at Senator Mikulski's website, "Health, Education, Labor and Pensions Committee (HELP)."

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