Thanks to the Affordable Care Act all individual and family plans now include coverage for maternity care. These new health services, many of which are provided at no cost to the patient, also extend to the new born. Prominent in many private health plans is coverage for routine infant circumcision.
Routine male infant circumcision is a covered benefit
Generally, all the rules, covered health care services and exclusions are found in the member’s Evidence of Coverage (EOC) document from the health plan. While some of the EOCs are quite explicit about the coverage of newborn circumcision, some plan documents are devoid of information, or worse, subject to interpretation.
Private health insurance specifies circumcision
Anthem Blue Cross, Blue Shield of California and Health Net all specifically mention routine infant circumcision as a covered benefit in the EOCs for their individual and family plans. Blue Shield and Health Net don’t specify the gender of the baby that can be circumcised in the EOCs that I searched.
Blue Shield of California PPO EOC
Pregnancy and Maternity Care Benefits
Benefits are provided for maternity services, including the following:
6) outpatient routine newborn circumcision within 18 months of birth.
**Circumcisions for Covered Persons aged 31 days and older are covered when Medically Necessary under “Outpatient Surgery and Services.” Refer to the “Outpatient Surgery and Services” section for applicable Copayments and Coinsurance.
Health Net PPO EOC
Professional (including elective terminations of pregnancy, genetic testing of fetus and circumcision of newborn**)
Health Net HMO EOC
Care for Conditions of Pregnancy
Circumcision of newborn (birth through 30 days)***
*** Circumcisions for members age 31 days and older are covered when Medically Necessary under outpatient surgery. Refer to “Other Professional Services” and “Outpatient Hospital Services” for applicable Copayments.
Anthem PPO EOC
Routine nursery care for the Newborn during the mother’s normal Hospital stay, including circumcision of a covered male Dependent and screening of a Newborn for genetic diseases provided through a program established by law or regulation;
Circumcision missing from some health plans
Other health insurance companies and health plans participating in the Covered California exchange for individual and family plans don’t mention circumcision as a covered benefit. I could find no mention of routine infant circumcision in member agreements or EOCs for Kaiser, Western Health Advantage or Chinese Community Health Plan. That doesn’t mean that circumcision won’t be covered under those plans.
Can baby girls be circumcised?
The failure of Blue Shield or Health Net to specify a gender eligible for circumcision may be attributable to the fact that the United States outlawed female circumcision practice in 1995 under the Female Genital Mutilation Act of 1995 . However, once a baby has been circumcised, female or male, it’s not a procedure that can be easily reversed. A Change.org petition signed by over 200,000 people calls on the Obama Administration to fund more research into the prevalence and severity of female genital mutilation that is still occurring in the United States.
Medi-Cal won’t cover circumcision
In contrast to private health individual health insurance, manage health care HMO plans issued to current and expanded Medi-Cal members are quite clear that circumcision is not a covered benefit. In other words, if the parents of a child enrolled in a Medi-Cal (Meidcaid) health plan want to circumcise their infant son for non-medical reasons, they will have to pay the full cost of the procedure. The health plan will make no contribution to the provider for the circumcision.
Anthem Blue Cross Partnership Plan (Medi-Cal) EOC
We do not cover these: Circumcision (if it is not medically necessary)
L.A. Care Medi-Cal EOC
The following is a list of services not covered by L.A. Care or by the regular (fee-for-service) Medi-Cal program:
Routine circumcision, unless medically necessary
California Health and Wellness
Circumcision Routine / Elective:Not Covered
Medically Necessary: Covered
Medically necessary versus cosmetic surgery circumcision
Central to all the private and public health plans that serve Medi-Cal members is that circumcision will only be covered if it is medically necessary. There are certain instances when the foreskin of newborn baby boy needs to surgically removed or repaired to correct an abnormality. Although, circumcision is viewed as cosmetic surgery in many respects.
Cosmetic surgery (surgery performed to alter or reshape normal structures of the body in order to improve your appearance) – L.A. Care Medi-Cal member handbook
Prostate cancer prevention
A recent study concluded that men who had been circumcised had a lower incidence of prostate cancer. From the abstract of BJU International, Circumcision and prostate cancer: a population-based control study in Montreal, Canada.
Circumcised men had a slightly lower risk, albeit not statistically significant, of developing prostate cancer than uncircumcised men (OR 0.89, 95% CI 0.76–1.04). Circumcision was found to be protective in men circumcised aged ≥36 years (OR 0.55, 95% CI 0.30–0.98). A weaker protective effect was seen among men circumcised within 1 year of birth (OR 0.86, 95% CI 0.72–1.04). The strongest protective effect of circumcision was recorded in Black men (OR 0.40, 95% CI 0.19–0.86, P-value for interaction 0.02) but no association was found with other ancestral groups.
Our findings provide novel evidence for a protective effect of circumcision against prostate cancer development, especially in those circumcised aged ≥36 years; although circumcision before the age of 1 year may also confer protection. Circumcision appeared to be protective only among Black men, a group that has the highest rate of disease. Further research into the differences in effect of circumcision on prostate cancer risk by ancestry is warranted, as is the influence of age at circumcision.
Just as many women are opting to undergo a double mastectomy to eliminate their risk of breast cancer , adult men might also consider circumcision after the age of 30 to reduce their risk of prostate cancer. In both situations, the prophylactic benefits of irreversibly altering one’s body are being done by adults that can make an informed decision. In the case of breast cancer, women can get a genetic test to see if they carry the “breast cancer genes” . Unfortunately for men, no clear link to either genes or STIs has been established with respect to intact foreskin and prostate cancer in adult men.
There are plenty of resources to help parents become informed about circumcising their newborn baby boy. Just because circumcision is a covered benefit of the health plan isn’t necessarily the best reason to opt for the procedure. It might actually be beneficial for the health plans that do cover circumcision to help educate mothers and fathers about what many people see as unnecessary cosmetic surgery on an infant that is at the complete mercy of the health care system.
Does my health plan cover circumcision?
The fastest way to determine if your health plan covers routine infant circumcision is to download the Evidence of Coverage document in a pdf file format. Under Edit> Find>Open Full Reader Search and type in circumcision and every page where the word is listed will be shown. You can also call your health plan to see if circumcision is covered if it is not listed in the EOC. Some of the EOCs for the various plans are listed on my website under Health Plans>Individual and Family> drop down menu of carriers. Not all carriers make their EOCs easily available online. If you learn whether your health plan covers “routine infant circumcision” let me know and I’ll add it to the list.
Other posts on circumcision