Does Health Insurance Cover Epidural?

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   Marlin McKelvy

   President, Consumer Directed Benefit Solutions, Memphis, Tennessee

   For contracts issued on or after January 1, 2014 I would say the answer is "Yes" for all health insurance policies as long as the Epidural was a part of an approved medical procedure.  And, I would be comfortable in saying an epidural would be covered when medically necessary under health policies issued before then, with the one possible glaring omission possibly being associated with maternity coverage in the individual marketplace in the past.  There are probably some people out there with grandfathered individual health insurance policies that did not cover maternity.  In the context of an older, grandfathered policy still in effect then for someone giving birth, where epidurals are not an uncommon part of the procedure, that would be a situation where an epidural would not be covered due to a specific exclusion allowed when the policy was issued.  Epidurals are also performed in other surgical and/or treatment settings than just maternity and so may show up in a variety of claim situations.  But an Epidural is generally performed as a requirement to perform some procedure and is usually bundled with the charges from that event.

   Answered on May 21, 2014

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