Claims were also a factor. In 2003, about half of PLICO's losses were paid on claims in which failure to perform a timely cesarean was alleged, Dr. Hook said.
But Dana Stone, M.D., an ob.gyn. in Oklahoma City, said she is concerned that coverage is being denied for a reasonable medical procedure.
Dr. Stone said she doesn't believe she can continue to offer VBAC in light of this restriction. To date, Dr. Stone said she hasn't had a patient ask to change doctors because she can't perform VBAC, but she says her colleagues have had patients who are seeking new physicians as a result.
These types of restrictions imposed by insurers aren't widespread, said Albert L. Strunk, M.D., vice president of ACOG's fellowship activities. In many cases, companies recommend adherence to practice guidelines, but the process is informal, he said.
Although the educational efforts for improving patient safety and care can be helpful, Dr. Strunk said, practice parameters that have as their primary goal the protection of the insurance company are inappropriate. It's also inappropriate for the insurer to impose practice requirements that would impair physicians in exercising their judgment in terms of patient safety, Dr. Strunk said.