Re: Blue Cross and uterine fibroid embolization

[Guest guest]

Carla:

I just looked into UAE under my Blue Cross and Blue Shield of Wisconsin

insurance and it was covered at 100%. The only problem was the doctor I would

go to in Milwaukee wasn't a covered radiologist but I go to him at 80% and pay

the 20%. If I were to switch to compcare it the he is under that plan and then

I wouldn't have any out of pocket. I refuse to switch to an HMO because I dont'

want a referral every time I go to someone. I would think that since Wisconsin

is so close to Illinois that BC/BS of Illinois would have the same coverage but

I am surprised that they dont.

I just wanted to let you know that in wisconsin it is covered for fibroid

removal.

Robyn

Carla Dionne wrote:

> Carole Flamm, M.D., M.P.H.

> Senior Consultant

> Technology Evaluation Center

> Blue Cross and Blue Shield Association

> 225 N. Michigan Avenue

> Chicago, IL 60601-7680

>

> Dear Carole,

>

> I don't know if you remember me or not, but I was the Patient Advocate that

> sat on the RAND/SCVIR research meeting that was held back in June in Santa

> .

>

> I have some questions about what has subsequently occurred with patients who

> have Blue Cross coverage that desire uterine artery embolization. It is my

> understanding that all patients with Blue Cross or Blue Shield coverage are

> now being denied reimbursement for UAE. Across the board -- across all

> states. Wow. What happened? I am currently covered by Blue Cross and my

> procedure WAS reimbursed -- but that was a year ago. I understand that

> things are very different today.

>

> As an active Patient Advocate for appropriate medical treatment for women

> with uterine fibroids, I am seriously concerned about this lack of health

> care coverage for women who subscribe to Blue Cross's medical insurance who

> have uterine fibroids. Open enrollment periods for insurance coverage are

> coming up across the nation in the next two months and the rumble on the

> internet list groups for many women is that they will not choose to

> re-enroll with Blue Cross. Was this the outcome of denial for this

> procedure that Blue Cross desired?

>

> In August, Aetna U.S. Healthcare announced complete coverage for this

> procedure across the nation (copy of policy attached).

>

> On October 18, United Healthcare announced complete coverage for this

> procedure across the nation.

>

> Blue Cross needs to come to the table on this issue or risk a serious

> capital bleed-out of women abandoning their Blue Cross coverage in favor of

> an insurance policy that will provide them with the medical care they need

> and desire.

>

> As you know, one-fourth of the women in this nation present with uterine

> fibroids. With the upcoming open enrollment period, I know that United

> Healthcare is a choice on my company's list of coverage options. Although

> I've already undergone UAE, I am appalled at the lack of coverage for the

> women I support through my advocacy. In all good conscience, if Blue Cross

> does not change its policy I, personally, will be forced to reconsider my

> re-enrollment with Blue Cross. In addition, I will not hesitate to openly

> advocate for those insurance providers that have, in fact, decided to lift

> the embargo against UAE.

>

> There have been approximately 6,500 UAEs performed worldwide to date -- with

> over 4,000 of those occurring in the United States. With follow-up in the

> United States on women dating only about 2 1/2 years there has been no

> evidence of recurring fibroids. With follow-up in Europe of 9 years, there

> also has been no evidence of recurring fibroids. With myomectomy, it is

> well known that recurrence can occur within the very first year

> post-procedure and a very high number of women continue on to require

> additional myomectomies within five years post-procedure. By comparison,

> UAE is a far more efficacious procedure.

>

> In terms of the argument that UAE may present with a certain percentage of

> women requiring additional procedures -- such as hysterectomy -- that cannot

> be denied. Statistics are clearly showing a post-UAE hysterectomy rate of

> 1-2%. However, please take a moment to compare that to the intra-operative

> complication rate and post-operative complication rate of hysterectomy that

> subsequently require additional surgeries related to the ureter, bladder and

> bowel -- hysterectomy as the purported definitive curative for uterine

> fibroids that your company, its employed gynecological reviewers of claims,

> and many others are so vehemently advocating -- and ask yourself how you can

> possibly use this figure as a financial reason to continue denying UAE

> coverage. Actually, I'd like the answer to that question myself. It's

> fairly clear to me that the financial numbers don't stack up at all in favor

> of hysterectomy or even myomectomy over UAE.

>

> Finally, the emotional drain of undergoing hysterectomy is clearly traumatic

> for hundreds of thousands of women who undergo that procedure annually.

> Besides their post-operative physical complications, many women -- over 50%

> according to RAND's review of the hysterectomy medical literature --

> experience serious psychological trauma post-hysterectomy. As for UAE, I

> have yet to meet a woman who seriously regrets their decision to undergo

> this procedure. Even women who have subsequently underwent hysterectomy due

> to infection or myomectomy due to clinical failure (possibly because of

> collateral blood supply to the fibroids other than that supplied by the

> uterine artery) do NOT regret having tried this procedure first. In fact,

> it gave them a sense of " knowing " that they had truly tried everything

> within their power to retain their uterus or attempt a less physically

> invasive procedure for treatment of their fibroids and it was simply not

> meant to be. Apparently, a certain sense of psychological " peace " can be

> made with that knowledge for women who subsequently undergo hysterectomy or

> even myomectomy. They tried this minimally invasive procedure and it

> failed. But, at least they tried. Nonetheless, the failure numbers are

> small compared to those undergoing myomectomy or hysterectomy who

> subsequently end up with a never-ending list of complications that require

> repeat visit after repeat visit to the operating room, the gynecologist's

> office, and even the psychologist's office for treatment of post-procedure

> psycho-social ailments.

>

> If there is ANYTHING I can do to convince Blue Cross and Blue Shield to

> change their policy coverage of UAE, I would certainly like to hear about it

> from you. In the meanwhile, Blue Cross and Blue Shield should probably

> begin preparing themselves for the subtle shift of women choosing

> alternative coverage. I personally predict that your enrollment numbers

> will most likely bleed only a little this year -- but you should be prepared

> for a major bleed out by the end of next year. Is that what you really

> want?

>

> Carla Dionne

> mailto:cdionne@...

> http://www.uterinefibroids.com

> member, /list/uterinefibroids

>

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[Guest guest]

>I just looked into UAE under my Blue Cross and Blue Shield of Wisconsin

>insurance and it was covered at 100%.

Do you have a copy of the coverage statement? If so, could you post it

please?

Carla

[Guest guest]

Carla no I don't have a copy of the statement but if I do go through with

the embolizaiton I will get a copy of it.

Robyn

Carla Dionne wrote:

> >I just looked into UAE under my Blue Cross and Blue Shield of Wisconsin

> >insurance and it was covered at 100%.

>

> Do you have a copy of the coverage statement? If so, could you post it

> please?

>

> Carla

>

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