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Private insurer refuses to pay out if a mother dies during childbirth

Australia’s largest private health insurer is changing its policy to no longer cover cases in which a mother does not survive childbirth.

Medibank, which holds about a 29.5 per cent share of the Australian private insurance market, has flagged maternal mortality, along with 165 other procedures, as an area it will no longer cover in a new hospital contract. If accepted, the changes will mean that the partner or family of the deceased will not only be left grieving and caring for a newborn, but also settling an $8,500 medical bill. Additionally, Calvary Health Care, a Catholic health group, stated that if a mother is in intensive care prior to her death, the bill could be as much as $5,000 a day.

Speaking at the National Press Club, Australian Medical Association president Professor Brian Owler described the move as “offensive.”

More: Heartbreak after mother dies unexpectedly after delivering quadruplets

“Unfortunately, maternal death can and still does occur in a very small number of cases — as tragic as that is,” he said, “Personally, however, I find it offensive that a private insurer would refuse to cover the costs of that patient and hospital in such a tragic event.”

This news is distressing. Losing a partner on what is supposed to be the beginning of one of life’s most monumental journeys is hard enough. Taking care of a newborn alone, while grieving and thinking about the future you thought you’d have is hard enough. Adding a substantial financial burden to that situation just seems outrageously cruel. The cynical part of me wonders whether perhaps this isn’t in some way related to Medibank’s poor performance in its first full year of trading.

Medibank has defended its changes by saying that they were in line with “common industry practice.” Private Healthcare Australia CEO Dr. Michael Armitage added that the move would demand “a certain level of quality and safety.”

More: Why are so many U.S. women dying in childbirth?

“Funds pay more when their members are subjected to poor care than they do for optimal care, but it is the member who suffers most in this scenario,” he said. “Privately insured Australians want their fund to advocate on their behalf.”

However, the CEO of the Consumers Health Forum, Leanne Wells, remains unconvinced. “The suggestion that a health fund should be exempt from paying benefits in the event of a mother dying during childbirth is harsh and unreasonable,” she said. “It highlights the need for the development of a clinically-led, nationally-agreed register setting out those avoidable, adverse events where health funds would be exempt from paying benefits.”

Owler added that anyone under the impression that a financial incentive will motivate medical staff to prevent maternal death more than they currently do has “no understanding of medicine or the people in it.”

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I’m inclined to side with Wells and Owler, in that the attempt at justifying the new policy by spouting higher medical standards is misguided. Medical professionals are human, which means that, occasionally, they, too, make mistakes. Sometimes those mistakes cost a life. For the most part, it isn’t due to gross misconduct or negligence. The professionals involved can be brought up on negligence charges and investigated. Nobody wants this to happen. Medical professionals want their patients to get better. Perhaps there is a way to minimise the threat of human error in certain areas, but threatening hospitals is not it.

Threatening insurance members is even more confounding. A pregnant woman has no say over how her medical team will perform. It is in her best interest to stay alive and there is nothing she can do to alter her destiny, so punishing her and her loved ones for medical mistakes (or, sometimes, unpreventable circumstances) makes no sense.

Personally, I’d be more interested in hearing Wells’ ideas about a nationally based solution. It seems that positive reinforcement, education and standards are a better way to target their problem. But until her idea of a register takes hold, my thoughts are with the victims: Medibank’s members.

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