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More Insurers Stop Reimbursing Power Morcellator Procedures

April 8, 2015 — One year after the FDA warned that power morcellators can spread cancer, several major insurance companies in the United States have stopped providing coverage or sharply restricted reimbursements for the procedures, according to the Wall Street Journal.

UnitedHealth Group, Inc., the largest health insurance company in the United States with about 40 million members, now makes doctors ask for authorization before most types of hysterectomies.

Last week, a spokeswoman for Aetna, Inc. said they are considering changes to coverage. Aetna is the third-largest health insurance company in the United States with about 23 million members.

Health Care Services Group (HCSG) is considering labeling power morcellation as “not medically necessary,” which means the procedure typically would not be eligible for coverage. The new policies would affect about 14.7 million members of Blue Cross and Blue Shield plans in Texas, Illinois, Montana, New Mexico, and Oklahoma.

Last November, Blue Shield of California deemed power morcellation an “investigational” procedure. The changes generally mean the procedure will not be covered, except in rare cases. About 3.5 million members are affected by the changes.

Similar restrictions have been enacted by smaller insurance companies in Pennsylvania, Massachusetts, Delaware, West Virginia, and Washington, D.C., according to the WSJ.

The largest manufacturer of power morcellators, Johnson & Johnson, pulled their products off the market after the FDA warned that they should not be used on the “vast majority” of women undergoing a hysterectomy or fibroid surgery.

The problem is that about 1 in 350 women who undergoes this procedure has undiagnosed uterine cancer. When the spinning blades of the morcellator are used to grind up fibroids, they can accidentally spread uterine cancer throughout a woman’s abdomen, greatly worsening her prognosis.

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