Health Insurer Gambles on the Odds
In a surprise move, and contrary to the majority of its competitors, a health insurance company stands fast in continuing to cover the routine use of morcellators despite restrictions by the regulatory body on its use in gynecological surgery.
The Food and Drug Administration (FDA) issued a succession of warnings regarding the dangers posed by using laparoscopic morcellators for hysterectomies and myomectomies. The FDA went so far as to require manufacturers to add a black box warning to their devices. Large hjealth insurance companies such as UnitedHealth Group Inc. and Aetna Inc. scented danger in the air and restricted or withdrew its cover of morcellation in their policies. Health Care Service Corp. (HCSC), however, decided to hold off on a draft policy that would have made morcellation “not medically necessary.”
Power morcellators have been in use since 1991, and it is a highly efficient and minimally invasive way to perform hysterectomies or myomectomies. This is a good thing for everybody concerned. The devil was in the details.
Laparoscopic morcellation involved cutting up the target tissue into small pieces and extracted through the small incision or throught he vagina canal. Everything would have been fine if the surgeon was able to get everything out, but in most cases small pieces of tissue was left behind in the uterine or abdominal cavity. If the tissue, usually a uterine fibroid mass or the uterus itself, contained hidden cancer cells, the scraps of tissue act like seeds and spreads the cancer. In other words, morcellator use and cancer growth appeared to be linked.
However, this did not scare HCSC into running for the hills. The company is keeping its ears close to the ground, waiting for the first sign of real trouble. They have the support of the American College of Obstetricians and Gynecologists, which wants the patient to have the freedom to decide on what option to take, provided that the doctor tells the patient about the pros, cons, and options for the procedure.