Thursday 2 February 2023
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Largest Health Insurer in the U.S. Tightens Coverage For Procedure Commonly Performed in Rochester

two doctors in hospitalThe largest health insurer in the U.S. announced at the end of February that it’s tightening its coverage rules on hysterectomies, surgical procedures that remove the uterus and are commonly used to treat uterine fibroids.

The company says that it will start requiring health care professionals, facilities, and providers to notify them in advance if they plan to perform any type of hysterectomy, and that they won’t approve the procedure if they conclude that it’s not medically necessary.

Although Rochester doesn’t have any physicians in UnitedHealth’s network, the announcement is worth noting. If Excellus BlueCross BlueShield, one of Rochester’s largest health insurers, follows suit, it could dramatically affect the way doctors in the Flower City treat fibroids. According to a 2011 study by a Highland Hospital doctor, the hospital performed the most hysterectomies in New York. With tighter coverage rules, doctors would no longer be able to recommend their most preferred procedure.

That being said, more restrictive rules on hysterectomies may be a good thing. A new University of Michigan study found that of the 400,000 hysterectomies that are performed each year, 20% were performed needlessly. This means that of the 695 Rochester women who underwent hysterectomies back in 2011, 139 women had their uterus removed unnecessarily.

“While many women need a hysterectomy and benefit from it, there are a significant number of women who may do better with other procedures that aren’t being offered,” said Lauren Streicher, MD, author of The Essential Guide to Hysterectomy.

Fortunately, there are a number of alternative treatments. Women do not have to have their uteri removed to have their fibroids treated. Instead, there are medicines that can help mitigate symptoms, and/or shrink the fibroids, as well as minimally invasive procedures which can properly eliminate the fibroids.

If your doctor recommends a hysterectomy to treat your fibroids, Streicher suggests getting a second opinion, saying that “very often women end up going on the recommendation of someone who isn’t necessarily an expert and won’t offer them all of the alternatives.”