A patient of mine, we’ll call her Rachel, had two pregnancies this year. The first one was complicated by a miscarriage at 14 weeks. She underwent an abortion procedure in the hospital. We subsequently found out her pregnancy was complicated by Fetal Trisomy 13, which ultimately led to the miscarriage.

Rachel was fortunate to conceive a second pregnancy. She underwent genetic testing given the previous pregnancy history and she found out this fetus was affected by Fetal Trisomy 18, another anomaly that often leads to miscarriage in the second or third trimester. We reviewed her pregnancy options together. She elected to proceed with an abortion.

Unfortunately, her insurance would not cover this procedure even though they had covered the exact same procedure the first time.

When I called to give her the news, she asked me, “What is different from the last one?” I replied, “A heartbeat.”

Rachel is a physician herself. She was astonished and outraged that her insurance would pay for the procedure for one scenario but not the other. That they would wait for this heartbeat to stop, too, before covering the procedure, while her health risks continued to increase as the pregnancy continues further. I appealed to the insurance company but was denied as the company does not cover “that procedure.”

I am committed to providing comprehensive gynecology care to all women, but this time I could not, due to a barrier caused by the insurance company and policy. I was prevented from carrying out a procedure I can do safely and with minimal risk, especially compared to the risk of letting her continue on with the pregnancy with a fetal anomaly that would not allow the fetus to survive much past birth.

Emotionally, my patient is struggling, having experienced two fetal anomalies within six months. She would like have an abortion but cannot afford to have it done without insurance coverage. Now she waits, and I feel helpless on her behalf.