UnitedHealth, the country’s largest insurer, will soon require doctors to get permission before performing most types of inpatient hysterectomies, a procedure in which the uterus is removed, often to prevent or treat cancer.
The move follows lengthy debate over a surgical device believed by many medical researchers to spread cancer in patients -- and highlights how insurers can also play watchdog.
Sharper limits on procedures are an old cost-cutting tool in the insurance business, said Sabrina Corlette, a senior research fellow at the Center on Health Insurance Reform at Georgetown University. But they typically apply to new or elective surgeries. Hysterectomies are often necessary for patients with life-threatening tumors.
So it’s natural to wonder: Does your insurer really know better than your physician?
“These decisions are best made between a physician and a patient, not a third party administrative decision-maker,” the American College of Obstetricians and Gynecologists told the Wall Street Journal.
“I don’t really want them telling me what type of hysterectomy I should be doing,” added Mike Norgard, a gynecologist, in the same story.
UnitedHealth will now require special approval for all non-vaginal hysterectomies. Vaginal hysterectomies, which tend to cost less, account for less than one-third of total hysterectomies performed each year.
But UnitedHealth says it is limiting the procedure to vaginal hysterectomies because they produce better outcomes and fewer complications. The company aims to curb use of laparoscopic power morcellators, or electric blades used to extract tissue through abdominal incisions. Scientists say the devices can miss bits of cancerous tissue that grow into new tumors, boosting the risk of cancer fatality.
The Food and Drug Administration has also weighed in, recently declaring that doctors shouldn't use the device -- commonly used during abdominal procedures -- on most women. The FDA started investigating morcellators two years ago, after a Wall Street Journal story shed light on a prominent cancer case in Boston. Dozens more patients have since reported that morcellation might have worsened their cancers. (Young women who wish to preserve their fertility may request the procedure to remove harmful tissue without undergoing a full hysterectomy.)
But beyond the immediate health concerns, some worry about insurance companies limiting the procedures. Aetna and Cigna, two other major insurers, are not following suit.
“Is it appropriate for the insurance company to stand in the shoes of the doctor and say, ‘We know better?’” Corlette said. “Well, evidence has built up over years that suggests -- as much as we hate to think this -- that doctors are motivated by financial reasons. When doctors are paid per procedure, you see they perform lots of procedures.”
UnitedHealth will start enforcing its stricter hysterectomy rules in April.
Vaginal hysterectomies performed on an outpatient basis won’t require preauthorization by UnitedHealth. The method, which does not use morcellators, is considered by many doctors as a cheaper and less invasive option.