Reproductive Autonomy and Insurer Denials of Care: The Fine Line Between Oversight and Interference

AbstractReproductive autonomy is a fundamental ethical principle in healthcare, yet insurance denials of care often undermine patient decision-making. This article examines a case in which a 35-year-old patient with stage 4 endometriosis sought a total hysterectomy and bilateral salpingo-oophorectomy to manage severe, refractory pelvic pain. Despite the patient's informed and autonomous decision, her insurer denied authorization based on a paternalistic concern for her future fertility. Through an ethical analysis, this article critiques the role of insurers in reproductive decision-making, highlighting the inherent conflict of interest, lack of clinical nuance, and burdens imposed on clinicians. The disproportionate scrutiny of sterilization procedures, rooted in a history of reproductive injustice, further complicates the ethical landscape. To address these challenges, we propose integrating interinstitutional ethics consultations into prior authorization processes, ensuring that patient autonomy is respected while maintaining oversight for medical necessity. This case underscores the need to balance oversight with respect for reproductive autonomy to optimize patient care and equitable access to necessary procedures.