MINNETONKA, Minn. — In light of the recent FDA warning and public uproar over the use of power morcellators, the largest health insurance provider in the country has tightened its rules on performing the procedure.

In early April, UnitedHealth group will require doctors to obtain authorization from the insurance company before performing most types of hysterectomies.

The purpose of this new rule is to limit the use of power morcellators in hysterectomy procedures. In its February 2015 Network Bulletin, UnitedHealth references the American Congress of Obstetricians and Gynecologists identified preference for vaginal hysterectomies rather than laparoscopic/abdominal hysterectomies (i.e. those performed using a power morcellator).

To align with the ACOG’s recommendations and lead to the best outcomes, the insurer will now require authorization for abdominal hysterectomies, laparoscopic hysterectomies, vaginal hysterectomies, and laparoscopic assistant vaginal hysterectomies. Failure to seek prior authorization will result in a denial of the claim and denial of billing for the provider. UnitedHealth will review these approvals according to its new medical policy statement, which specifically cites the most recent FDA warning and other medical data in favor of vaginal surgery rather than abdominal laparoscopic.

Uterine Morcellation

Uterine morcellation is a popular method used by surgeons to remove benign fibroids from the uterus and to perform hysterectomies. The tool used is called a power morcellator. The surgeon cuts a small incision in the abdomen and the power morcellator is used to slice up the fibrous tissue into tiny pieces so they can be sucked through the small cut. The result is a quick and minimally invasive procedure. Unfortunately, undetected forms of uterine sarcoma (cancer) are often mistaken for fibroids. It is impossible to discern the difference between the two, especially as the cancerous cells often are dormant for many years. When the power morcellator shreds the tissue, it puts women at a serious risk. The malignant cells are scattered throughout the body and can result in very aggressive and hard-to-treat cancer awakening and spreading.

Studies have found that 1 in 350 women who undergo power morcellation for benign tissue removal will then have uterine cancer. In response, the FDA issued an extremely strong warning against the device. While the warning does not outright ban the use of power morcellators, the device’s warning was updated to reflect the risk of spreading cancer.

UnitedHealth is the largest insurer in the country so this decision affects more than 40 million health insurance customers and can result in systemic change. The policy change would apply to all of its commercial customers. It has the potential to force surgeons who still want to use the power morcellator to seriously rethink their decision and choose another option if they wish to be able to bill the procedure to the insurer. In the long run, this will have a positive effect on limiting the number of women who undergo morcellation and are exposed to deadly cancer.

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