United Healthcare Tightens The Screws On OBGYNs

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

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