Women have medical choices when it comes to treating uterine fibroids. Yet why are many unaware of them? One reason may be the difficulty with obtaining medical insurance coverage to pay for the alternative method of treating uterine fibroids. But women need not feel alone in seeking help with potential medical reimbursement obstacles, or from gaining access to information and support about which medical treatment to choose.
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Insurance reimbursement for embolization varies depending upon the patient’s diagnosis, insurance coverage, and the location of the hospital.
Most insurance carriers pay for UFE if it is medically necessary. Talk with your doctor and interventional radiologist about this before the procedure. They will know which healthcare providers have a policy that covers UFE and which ones need more information about the procedure.
If reimbursement is denied, your doctors can help you make an appeal to the insurance company.
Check the Society of Interventional Radiology (SIR) website for a complete list of insurance carriers that cover this procedure.
An alternative method to treating uterine fibroids is by cutting off the fibroid’s nutrient supply, causing the fibroid to shrink away. This method is called uterine fibroid embolization, or UFE. It uses minimally invasive technology – as opposed to a hysterectomy, which involves intensive surgery and a lengthy recovery. UFE has a 90% success rate and many patients are willing to testify to that fact. In fact, many of these patients have spread the word of their success with UFE among friends, family and co-workers, increasing the treatment’s popularity.
Yet despite this mounting record of success, women still encounter hurdles when it comes to medical insurance reimbursement for UFE. Some carriers – willing to pay for a substantially more expensive hysterectomy -- reimburse physicians at rates far below actual costs for UFE. Still other carriers maintain that fibroids are considered a "pre-existing condition," denying insurance coverage altogether.
For a patient with symptomatic fibroids who wants to explore UFE but finds that her insurance does not cover it, what are the alternatives? Hope Waltman, a fibroids patient herself and the founder of the Hope for Fibroids Organization, has discovered several encouraging answers to that question. First, it is often possible to appeal an insurance company’s decision not to provide reimbursement for UFE. Second, many care providers will make arrangements with a patient who must cover the cost of the procedure herself.
According to Dr. Worthington-Kirsch, an interventional radiologist and a contributing physician to the Hope for Fibroids website (www.hopeforfibroids.org), patients who have been denied full reimbursement for UFE should avoid contacting their insurance company directly about clearance for the procedure. Instead, they should allow their interventional radiologist — who has a staff trained in dealing with complex insurance bureaucracies —to handle the process. Dr. Worthington-Kirsch adds that many physicians and hospitals are willing to work with patients who must cover all or most of the cost themselves. As a result, while it may require extra effort on the part of the patient, UFE remains available to many women who are initially denied coverage for the procedure.
What about patients who have been turned away by an insurance provider because of fibroids? Most states provide High-Risk Pool Plans, an option for patients who have been denied coverage by other insurance providers. Waltman has compiled a detailed list of contact information, by state, for these plans. It can be found at http://www.hopeforfibroids.org/insurance.html.
The Hope for Fibroids website provides well-organized answers to hundreds of frequently asked questions. The site features sensible, helpful information from several expert physicians about UFE. To find out more about the appeal process or to view appeal letters written by other patients, visit www.hopeforfibroids.org. More specific information about fibroids, including interviews with physicians who have pioneered UFE, can be found here at www.fibroids1.com.