Sat | Apr 4, 2020

Punished for pregnancy - Medics reject insurance cards for ‘single’ plans, expectant mothers forced to pay out of pocket

Published:Sunday | June 2, 2019 | 12:30 AMNadine Wilson-HarrisStaff Reporter

Some women have resorted to putting a male friend on their insurance plans to change their status from single to family prior to getting pregnant due to the challenges being experienced by expectant mothers locally to pay for prenatal care.

This was revealed by president of the Nurses’ Association of Jamaica, Carmen Johnson, who said she was informed that some insurance companies are refusing to finance medical services during pregnancy for women who are on a single plan.

“What some women complain about is that when they go to the antenatal clinic, and when they go in for their deliveries, they are not able to use their health card if they are not married,” she told The Sunday Gleaner.

“So what it forces some women to do – even before they are pregnant – is to put a man on their health insurance plan,” she said.

She said that this concern was revealed by women during general discussions and focus groups sessions.

THE PLAN

“What some explain is that though they may not be in a serious relationship, ... what they do is that they put whoever they have as a friend on it and they and that gentleman may not be together, but it doesn’t matter, they already have a plan,” she explained.

She said women were always complaining that health facilities were refusing to accept their insurance cards to pay for medical services rendered while pregnant, but she said some are now raising the issue of being sidelined because they do not have family coverage.

“Even when they come to the facility and you ask them for it, they will tell you that it doesn’t make sense because when they visit their private practitioner for antenatal clinic, they were not able to use it,” she said.

A Sunday Gleaner story published last year March revealed that pregnant women were being asked to pay upfront for medical services and then claim from the health insurance company after. 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.

One expectant mother complained then that every medical facility she had visited refused to accept her health card upfront.

“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,” she lamented.

President of the Jamaica Network of Rural Women Producers, Tamisha Lee, also took issue with this policy.

“Pregnancy is not abnormal, pregnancy is not a disease. It is something that is beautiful, and as it relates to other maladies like cancer and so on, they pay upfront, so why is it that pregnancy is treated that way?” she asked.

DON’T BLAME DOCTORS

Gynaecologist/obstetrician Dr Charles Rockhead said then that medical practitioners were not to be blamed for the policy.

“We don’t have a choice. We are just doing what we are instructed to do by the insurance company,” he said.

“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.

A meeting was held with members of the Partnership for the Promotion of Patients’ Rights in Maternal, Neonatal and Infant Health (MNIH) in Jamaica project and representatives from two local insurance companies and from the Insurance Association of Jamaica following the publication of the article.

The health insurers contended then that most Jamaicans do not know enough about the health benefits offered under the insurance policies they hold. They felt that more needed to be done to improve awareness on how to access the best public healthcare possible, especially among expectant mothers.

Advocacy specialist with the MNIH project, Linnette Vassell, said the complaint was raised about women being asked to pay out of pocket for prenatal care.

“When the discussion took place, the companies – the two big companies who were involved – said that they did not get that as a challenge because they found that a lot of women want to save the insurance for the delivery,” she noted.

About a quarter of Jamaica’s population and a third of the workforce have health insurance. In 2017, health insurers paid out $154.7 million for maternity benefits, and between 2014 and 2016, one per cent of overall benefits were paid out for maternal care.

nadine.wilson@gleanerjm.com