A survey of Connecticut's major insurers by Attorney General Richard Blumenthal has found that most major insurers in the state limit hospital stays for new mothers and infants to 24 hours.
Fourteen of 20 insurers responding to the survey said a 24-hour stay is the policy for covering routine childbirth.
At a women's health conference late last month, Blumenthal said the results confirm "a very troubling trend toward pervasive, prevalent pressure on new mothers to leave hospitals too soon after childbirth." He said the results would be used to draft legislation to ensure that mothers and their infants get the care they need.
Interestingly, the survey also found that all 20 respondents will authorize a longer stay if the physician says it's medically necessary.
"That was overlooked in the attorney general's comments," said Keith Stover, an HMO lobbyist. "I have not found an HMO that does not let a physician determine the medical appropriateness of an early discharge."
While insurers may allow physicians to obtain approval for an extra day, "they're making it difficult for the physicians to do that," contended Michael Tesoro, M.D., chairman of the Connecticut section of the American College of Obstetricians and Gynecologists. In addition to repeated phone calls to pre-certify a longer stay, physicians whose patients exceed the norm also face the threat of disciplinary action, he said.
According to the attorney general's office, five insurers indicated they take such "disciplinary action," which may include "education" or dropping physicians from the network. They are Blue Cross and Blue Shield of Connecticut, HealthChoice of Connecticut, Physicians Health Services, Oxford Health Plans and M.D. Health Plan.
However, industry and plan representatives denied the allegation. "Nearly every HMO that I know engages in ongoing review of practice patterns," not in any kind of a sanction, HMO lobbyist Stover said.
Another industry representative who declined to be identified said it's common for a physician who exceeds general length-of-stay guidelines to face a peer review panel and possible corrective action, but he believes the attorney general has misinterpreted the survey results.
In recent days, Greenwich (Conn.) Hospital and Norwalk (Conn.) Hospital have offered to cover an extra day of care if insurers won't. Greenwich expects to spend an additional $200,000 or more per year if maternity business increases substantially, said Frank Corvino, its president.