April 8, 2015 — Several major health insurance companies have dropped or are considering dropping coverage for procedures involving laparoscopic power morcellators.
The Wall Street Journal reports that the changes will affect about 93 million Americans.
One year ago, the FDA warned that power morcellators should not be used in the “vast majority” of hysterectomies and fibroid surgeries because they can spread cancer. However, no recalls were issued and many doctors continued to use them in hysterectomies and fibroid surgeries.
The FDA may be limited in its reach into clinical practice, but doctors are now under pressure from another side — insurance companies who have stopped providing coverage or reimbursing its use.
UnitedHealth Group Inc., the largest insurer with 40 million customers, now requires doctors to obtain authorization from the insurance company before performing most types of hysterectomies. Until recently, morcellators were used in thousands of hysterectomies per year.
Aetna, Inc., the third-largest insurer without about 23 million customers, told the WSJ they are exploring changes in their coverage of morcellators.
Health Care Service Group, the fourth-largest health insurer with 14.7 million customers, has proposed labeling power morcellation as “not medically necessary,” which means the procedure would not normally be eligible for coverage. The changes would affect Blue Cross and Blue Shield units in Texas, Illinois, Montana, New Mexico, and Oklahoma.
Blue Shield of California, which has about 3.5 million members, declared power morcellation for fibroids an “investigational” procedure last year, which means the procedure generally wouldn’t be covered.
Several smaller insurers in Pennsylvania, Massachusetts, Delaware, West Virginia, and Washington, D.C., have also stopped providing coverage of deemed the use of morcellators “not medically necessary.”
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