UnitedHealth Tightens Rules on Hysterectomies

UnitedHealth Tightens Rules on Hysterectomies | Pintas & Mullins Law Firm

The country’s largest health insurer, UnitedHealth Group, recently announced that it was tightening the rules around hysterectomies and the use of power morcellators. Doctors will not have to gain specific authorization to perform surgeries with morcellators, which are now linked to uterine cancer. Our team of uterine cancer lawyers details these new rules.

Starting in April 2015, doctors in United’s network will have to get authorization before performing a hysterectomy with a power morcellator. Other types of hysterectomies, such as vaginal hysterectomies performed on an outpatient basis, will not require pre-approval.

Putting Lives at Risk

UnitedHealth is that latest company to take action against the medical devices known as a laparoscopic power morcellator. The problems with these devices became a topic of public debate in 2013, when an esteemed physician, Dr. Amy Reed, was diagnosed with an aggressive form of uterine cancer after undergoing a power morcellation surgery.

Neither Dr. Reed nor her doctors knew she had cancerous uterine cells before the surgery, but the power morcellator spread the cancer throughout her uterus and significantly worsened her likelihood of survival. Power morcellators work by cutting fibroids and other tissue with tiny spinning blades so they can be easily removed through a small incision. Fibroids often contain cancerous cells, which are spread throughout the uterus when cut up by the power morcellators, worsening the prognosis and survival outcome.

Worsening the issue, there is no reliable method to test for uterine cancer presence before surgery because the cancer cells live in the thick muscle or tissue of the uterus, making testing nearly impossible. Medical experts have tried for years to develop better testing methods, to no avail.

This type of procedure was offered to women as the most minimally-invasive option for hysterectomies and myomectomies. Recovery takes between two and four weeks, and patients are able to be back home the same day and return to normal life much faster than with traditional surgery, making it a tempting option for busy women.

Like thousands of other women, Dr. Reed was never told the morcellation surgery could spread hidden cancer, and the risk was not included in the informed consent papers. About 500,000 hysterectomies are performed every year, only 10 -15% of which are vaginal procedures performed on an outpatient basis, which is the only method that UnitedHealth will fully allow.

Outpatient vaginal hysterectomies do not use power morcellators and are considered the least invasive and least expensive method. Doctors believe this procedure is underused because it is not emphasized enough in medical training. Now that UnitedHealth is allowing only this type of hysterectomy to be performed without pre-approval, many are hoping it will spur broad clinical changes and hopefully improve training.

More than 40 million Americans are insured under UnitedHealth, and the insurer is trying to do more for their customers to ensure they received the safest, most effective treatment. Outpatient vaginal hysterectomies are not only the safest and most efficient, but the least expensive as well. According to the American Journal of Obstetrics & Gynecology, these surgeries cost about $7,900, while power morcellation hysterectomies average around $11,500, and robot-assisted hysterectomies cost around $13,400.

It can take days or weeks to get authorization from insurers for procedures, which can drag on evn longer if the company would like the doctor to consult one of their own medical experts. This new policy does not, however, cover hysterectomies for cancer treatment purposes.

Morcellation procedures have become so popular due in large part to the lobbying of medical device manufacturers. Companies like Johnson & Johnson often send sales teams out to hospitals and incentivize doctors to use their products, marketing devices like morcellators to doctors as a high-tech tool that will make the surgery easier. 

Many of the country’s top hospitals have banned morcellation hysterectomies completely, and Johnson & Johnson voluntarily recalled three of its morcellators after the FDA released a statement urging doctors to stop using them. The agency stopped short of issuing a mandatory recall, allowing many doctors to continue using them.

Our uterine cancer lawyers are currently investigating cases of cancer diagnosis after power morcellation surgery nationwide. We provide free legal consultations to patients and families with any and all questions about this issue or any other medical device injury.