• United Healthcare Tightens The Screws On OBGYNs

    by Sharan Abdul-Rahman, MD
    on Mar 12th, 2015

Effective April 6, 2015, United Healthcare will determine if and how a hysterectomy (the surgical removal of a uterus) is performed.

Currently all insurance companies require prior authorization before a hysterectomy can be performed. Your OBGYN has to indicate the reason and get approval for the hysterectomy in order to get paid. Prior authorizations weren't always required by insurance companies. However, they have increasingly been required not only for procedures, but also for certain medications and treatments.

Effective April 6, 2015, UHC has stated that all hysterectomies except for vaginal hysterectomy
done on an outpatient basis will require prior authorization. Failure to complete the prior authorization process will result in claim denial. If it is determined that there was no medical necessity for the procedure irrespective of the how the procedure was performed, there will be a denial. UHC explains its rationale is that evidence has demonstrated that in general vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy.

As an OBGYN that no longer recommends hysterectomy as a first option for non cancerous indications, I say that it's just not that simple. Vaginal hysterectomies are typically done on smaller uteri. The smaller the uterus, typically the easier the removal and the fewer the complications. The larger the uterus, the more difficult the vaginal approach. The size of the uterus, the size of the woman and the ability to reach and adequately assess ovaries and tubes
are all factors that factor in determining the appropriate route. If it were that simple, OBGYNs would preferentially use this route and not need external pressure from insurance companies.

The problem is not in promoting the most efficient and least risky treatment. The problem is having medical decisions being made by insurance companies. Let's try transparency and let the patient and doctor decide on the best treatment. Provide the latest medical recommendations to both health providers and patients. In the our communities, provide statistical reports of the local providers. As an incentive, acknowledge and reward doctors that reach desired benchmarks or who have stellar patient outcomes. But stop interfering in the practice of medicine. Allow doctors to be doctors.

Author Sharan Abdul-Rahman, MD

You Might Also Enjoy...

Ways to avoid vaginal dryness

POST MENOPAUSE VAGINAL DRYNESS. More common than you might think.. affecting many women who are too embarrassed to speak about it.

What’s a Phthalate?

Phthalates are endocrine disruptive chemicals. They are present in our food, our beauty, health and home products. They are ubiquitous. They can pose health risks.

Updates on Female Sexual Health

Acknowledging that there is a need for a solution is the first step in solving the problem. Female sexual health is important. The following is an update as to what is currently available and what is needed..

ABORTION 2019

Recent changes at the state level are making the availability of having an abortion increasingly more difficult. Collectively, we need to consider if this makes sense for the well being of our society and not get entrenched in ideological battles.

WITH EACH MENSTRUAL CYCLE -- ARE YOU BLEEDING TOO MUCH?

Besides being embarrassing, excessive menstrual bleeding can lead to serious medical problems. Many women are having excessive menstrual flow and are unaware that their health issues such as fatigue, anemia are related to their heavy cycles.