Physio pressure triggers insurer U-turn on pregnancy-related injuries

Insurer Aviva has reversed its refusal to fund treatments for pregnancy-related injuries after pressure from pelvic health campaigners.

Pregnancy-related injuries may not be covered by health insurance

A member of the CSP’s Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) network raised the issue on a physio discussion forum when a patient reported that Aviva refused a claim for treatments for stress incontinence resulting from a recent pregnancy.

Physio-led campaign organisation PelvicRoar tweeted, ‘We are outraged that a patient was refused payment for physio for stress incontinence. Reason - they had a baby so it’s a consequence of their choice. Her husband‘s football related knee injury was covered. Obviously.’

However, after days of pressure from network members and campaigners, Aviva reversed its decision, saying it would not only pay out for the claim, but would 'review our terms and conditions with a view to covering physiotherapy for stress incontinence as a complication of pregnancy or childbirth,' according to a spokesperson for the insurer.

Chair of POGP Kate Lough said, 'This is a great first step. POGP supports any review of insurance policy that increases timely access to specialist care for women experiencing health problems across their lifespan as a result of pregnancy, childbirth and menopause.'

However, there were calls for an industry-wide review of insurance policies on birth injuries after other women with private health insurance shared their experiences of insurers turning down claims for their pregnancy-related treatments.

One tweeted, ‘I have a pelvic injury after a precipitous labour (not my choice!) and [my insurer] won’t cover me. I’m fuming, unbelievably sexist.’

Another added, ‘So glad to see this being raised! I’m thinking about starting a campaign to change the laws after I tried to get income insurance and was repeatedly told pregnancy related conditions NOT covered, but extreme sport injuries WERE!’

Though some physios pointed out that not all insurers adopted the same policy. Pelvic health and MSK physio Lisa Smith tweeted, ‘Shocking!!!! My patients had opposite with Axa PPP. They rang up to get an authorisation code for ' pelvic floor dysfunction' and '[Stress Urinary Incontinence]' The guy on the other end of the line couldn't get off the phone quick enough no questions asked.’

Pelvic physiotherapist and PelvicRoar co-founder Elaine Miller says, ‘The initial decision suggested that insurance companies believe birth injuries are a women’s choice.  

To cover a man’s sports injury but refuse a woman’s stress incontinence seems like discrimination on the basis of sex and maternity, both of which are protected characteristics.

She added that there were wider issues at stake. ‘The government is putting money into women’s health, but some services are stretched, some are at breaking point and some are absolutely fine – so women have a postcode lottery.

‘Those who are able to go private for physio, have an effective, very good value for money service.  However, if a woman wants to use her insurance to pay for it, they say pregnancy is a lifestyle choice, which is ridiculous. For a start, not all women are pregnant through choice.

‘Pregnancy can be dangerous and delivery can cause life-long changes to her body. Stress Urinary Incontinence (SUI) is very common, and leaking in the first six weeks post-natally doubles her risk of post-natal depression. 

‘It also stops her from exercising – and as we know coronary heart disease is the most common of premature death in women in industrialised countries.’

Senior women’s health physiotherapist and co-founder of PelvicRoar Myra Robson added. ‘It’s been amazing to see the strength of response to this issue, and to see so many people calling for change.’

Lough added, 'Pregnancy and childbirth are considered normal events in a woman’s life and POGP would always support a woman’s choice in this matter. This does not mean that there might not be consequences that impact on a woman’s health at that time, or beyond, affecting future quality of life and fitness.

'Women are encouraged and prompted to look after themselves during pregnancy and are helped to do so. Where they have problems such as stress urinary incontinence, psychological sequelae and ongoing musculoskeletal issues they should not be penalised by insurance companies employing algorithms that make seeking the right treatment difficult or impossible for those with limited resources and time.'

A spokesperson for Aviva said, ‘We have contacted the customer directly to discuss her claim and to apologise that the conversation we had concerning her claim did not meet the quality we would normally give.

'We have also listened to feedback on this matter and we intend to review our terms and conditions with a view to covering physiotherapy for stress incontinence as a complication of pregnancy or childbirth.

'Private medical insurance does not cover all medical conditions as to do so would make the cost prohibitive and it is designed to complement health services provided by the NHS.

'The reason that stress incontinence as a result of pregnancy and childbirth has not historically been covered is not due to lifestyle choice, but has been due to decisions that we have taken about the conditions that are covered. We believe our cover in this instance has been consistent with other providers across the industry.'

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