Have you been denied Health
Insurance because of Uterine Fibroids?
By Hope Waltman
When women are diagnosed with uterine fibroids disease they are faced with
two complex issues to research, treatments options and insurance coverage.
Some women have even experienced being denied the right to purchase personal
health insurance because their fibroids are considered a pre-existing
To help Americans who are confronted with this issue State and Federal
levels have implemented legislation as follows:
In some states, State Legislatures have created "High Risk Pool Plans" to
help residences that are considered uninsurable or have a pre-existing
medical condition. Each state has different rules, regulations, and health
plans for their residents.
At the Federal level COBRA (Consolidated Omnibus Budget Reconciliation Act
of 1996) was created to help people who left a company that hired 20 or more
people. If the company you left had 20 or more people, it must offer you
insurance up to 18 months (if you meet certain requirements). The individual
would have to pay for the insurance premiums.
HIPAA (Health Insurance Portability and Accountability Act passed in 1996)
is another Federal act that allows you to obtain group coverage from a new
employer without having to satisfy a waiting period for pre-existing
conditions. One requirement is that you've had 12 months of 'creditable
coverage' and haven't been uninsured for more than 63 days. (Note: For HIPAA
and COBRA research ALL the rules and regulations.)
Insurance coverage and 'pay her own way' issues to research.
What should a patient look at when deciding on a health insurance policy?
Paul Indman, M.D., FACOG, a Gynecologist who has a private medical practice
in Los Gatos, California, replied, "It is important to find a plan that has
reasonable out of network benefits. Otherwise a woman may get a great
bargain on a hysterectomy she doesn't need. Most of the MD's I know that contract with insurance do very
little conservative treatment, since they are often reimbursed at less than
the cost of providing the care. So if someone is caught in an HMO, it may be
impossible to get coverage for anything but a hysterectomy."
Uterine Artery Embolization (UAE) is a fibroid procedure that is performed
by an Interventional Radiologist. Does the Gynecologist or Interventional
Radiologist start the pre-certification process for the UAE?
Robert Worthington-Kirsch, M.D.,
FSCVIR, an Interventional Radiologist who has a private medical practice at
Roxborough Memorial Hospital, Philadelphia, Pennsylvania, said, "Unless
a woman's insurance company has rules that state otherwise, it should be the
responsibility of the Interventional Radiologist to obtain ALL insurance
pre-certifications and clearances, and to assist with any or ALL appeals.
It is not the task of the referring gynecologist, primary care physician, or
patient. I actively discourage patients from calling their insurance
companies to check on or obtain clearances, since this requires some
expertise in negotiating the health system. My staff has this expertise."
How does a physician bill a patient who has a health insurance policy, but
the doctor doesn't accept the insurance plan?
|William Parker, M.D., FACOG, a
Gynecologist who has a private medical practice in Santa Monica, California,
replied, "Some physicians' offices, who don't
accept health insurance, will prepare all the paperwork and send the surgery
bill to the insurance company. The patient will be billed for the balance.
Also, some of the procedures, such as hysteroscopy and D&C, can be done in
our office. This avoids the expense of going to a hospital and helps keep
the cost down."
What should a woman 'paying her own way' consider when going for a fibroid
Dr. Worthington-Kirsch and Dr. Indman said the following should be
1. The doctor's experience, training, expertise, and success rate with the
fibroid treatment they perform.
2. Compare prices for the doctor and hospital stay in the area you are
considering to have the procedure performed. Too many times women don't
realize the doctor and hospital cost of a procedure may vary by thousands of
dollars. One example of this is Uterine Artery Embolization medical costs.
Some physicians quote $7,000.00 for the physician fee, UAE procedure, and
staying overnight in the hospital. While other doctors, located in the same
city, may quote as much as $16,000.00 for the same procedure and hospital
3. When comparing prices, you should also think about value rather than just
the dollar amount. A low-cost procedure you don't need isn't a bargain.
Neither is a procedure that is poorly done, even though the cost of the
treatment is cheaper. Doctors that have special expertise in fibroids may be
somewhat more expensive than doctors with little experience (the money spent
on an experienced physician is money well spent because the success rate of
the procedure may be higher).
4. Ask about additional costs. MRI/ultrasound tests, anesthesia, pre-op
tests, and physician consultations may not be included in the amount and are
I asked Dr. Worthington-Kirsch and Dr. Indman, "What could Interventional
Radiologists and Gynecologists do to help a patient who has to pay her own
"Most physicians and hospitals are willing to discuss arrangements for
patients who have to pay their own way," said Dr. Worthington-Kirsch.
"Although I don't contract with insurance companies, my office will bill the
insurance company for the patient. I also do in office hysteroscopy, which
is much less expensive than doing the procedure in a surgical center.
Many times hospitals are willing to give large cash discounts for patients
without health insurance in whom the full amount would present a hardship. I
often can get hospital services at a fraction of the regular rate," replied
Dr. Indman, who is a Staff Physician at Good Samaritan Hospital of the Santa
Clara Valley, San Jose, California.
High Risk Pool Plan information for all the states, examples of Appeal
Letters, Self-Funded Insurance Plans information, and State and Federal
contact information can be found at the following URL http://www.hopeforfibroids.org/insurance.html.
Uterine fibroids treatment options
The fibroid treatment options are the following: Hysterectomy, Myomectomy,
Uterine Artery Embolization, medication-drug therapy, and watchful
Depending on the physician's experience and training Myomectomy can be
performed using a laparascopic, hysteroscopic, or abdominal technique.
Hysterectomy can be performed laparascopic, vaginal, or an incision can be
made in the abdomen. For women who are looking for a less invasive procedure
there is Uterine Artery Embolization (UAE).
A more detailed description of the fibroid treatments is available in the
"Fibroid Treatment Guide", which can be found at the following URL http://www.hopeforfibroids.org/faq2pg2-videoresearchandtreatments.html.
About the Author: Hope Waltman was diagnosed with uterine fibroids in 2001,
and had the Uterine Artery Embolization procedure performed the same year.
In 2002, she created the Hope For Fibroids Organization to help people with
their uterine fibroid research. She has published several articles in
magazines, and is Hope For Fibroids web site Webmaster. She can be contacted
at the following e-mail address firstname.lastname@example.org.
Reprinted by permission of Hope Waltman, Founder of the Hope For Fibroids