UnitedHealthcare is placing new restrictions on certain types of hysterectomy, which is one of the most frequently performed surgical procedures in the United States.
The nation's largest insurer says the move fits with a call from doctors to promote the use of vaginal hysterectomy, the surgical approach linked with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy when feasible.
The policy change comes after the Food and Drug Administration in November highlighted safety concerns about devices called laparoscopic power morcellators that are used in gynecological surgery, according to the UnitedHealthcare policy.
The company is the nation's largest health insurer, and a division of Minnetonka-based UnitedHealth Group Inc.
"To provide better outcomes for members, UnitedHealthcare will require prior authorization for commercial members for certain hysterectomy procedures for benign conditions starting April 6, 2015," the company said in a statement. "Vaginal hysterectomies performed in an outpatient hospital or ambulatory surgery center do not need prior authorization."
While a leading physicians group says it prefers vaginal hysterectomies, the American College of Obstetricians and Gynecologists (ACOG) nonetheless took issue with UnitedHealthcare's decision.
"Many factors are considered when making decisions about the ideal route of hysterectomy for each individual patient," the group said in a statement. "These decisions are best made between a physician and a patient, not a third party administrative decisionmaker."
Hysterectomy is a surgical procedure to remove the uterus and, in some cases, the ovaries and fallopian tubes, as well. It can be used to treat benign conditions such as uterine fibroids, endometriosis, pelvic organ prolapse and abnormal uterine bleeding.
Between 2000 and 2004, about 600,000 hysterectomies were performed each year in the United States, according to an ACOG committee opinion. Only 22 percent of cases at the time were performed vaginally — meaning the uterus is removed through the vagina. During the time period, about two-thirds were performed abdominally, while about 12 percent were performed through laparoscopic procedures, according to the physicians group.
In an abdominal hysterectomy, the uterus is removed through an incision in the lower abdomen. Doctors performing laparoscopic procedures operate through smaller incisions.