what are health insurers doing to curb the risk of power morcellators

In our previous post, we discussed how many women planning to undergo either a hysterectomy — the surgical removal of the uterus — or a myomectomy — the surgical removal of uterine fibroids — now have concerns about whether the procedure will be performed using a power morcellator.

As it turns out, however, they may no longer have to be so concerned, as recent reports indicate that a large number of U.S. health insurers, covering roughly 93 million people, are now actively working to restrict use of power morcellators in these types of procedures.

Why are insurers looking to restrict the use of power morcellators?

The move by insurers to restrict the use of power morcellators, which are designed to cut uterine tissue into smaller segments that can be removed laparoscopically, was hastened in large part by the recent actions of the federal government.

Specifically, the Food and Drug Administration reported last April that as many as one in 350 women undergoing myomectomies could have uterine cancer and that power morcellation could actually serve to spread this malignancy throughout the abdominal cavity. Even more significantly, the agency stated in November that power morcellators shouldn’t be used in the majority of surgical procedures and called for black-box warnings, the highest possible caution, to be used immediately for the devices.

How are insurers working to restrict the use of power morcellators?

Insurers have taken definitive measures such as declaring procedures calling for power morcellation “not medically necessary,” meaning they won’t be eligible for coverage, or “investigational,” meaning they won’t be covered in the majority of cases.

Furthermore, UnitedHeath Group, Inc., the largest insurer in the nation, now requires physicians to secure authorization for all hysterectomies, excluding outpatient vaginal procedures performed without a power morcellator.

Have any insurers here in Pennsylvania restricted the use of power morcellators?

Yes, both the UPMC Health Plan and Highmark Inc. have stopped reimbursing hysterectomies performed using power morcellation over the last several months.

How are physicians reacting to this?

Reports indicate that while most physicians don’t have much of an issue with the stance taken by insurance companies concerning power morcellation, there are some who feel that it shouldn’t be taken off the table completely given that some women may have unique medical concerns.

It’s going to be interesting to see how this transpires over the coming year. Still, it’s encouraging to see insurers recognize this very real threat to patient safety.

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