Insurance and fibroids

Insurance covers financial risks related to health conditions, while fibroids are noncancerous uterine growths affecting up to 70% of women by age 50. Health insurance policies typically cover medically necessary treatments for symptomatic fibroids, such as myomectomy or hysterectomy.

Insurers may deny coverage for elective procedures like uterine artery embolization unless symptoms meet severity criteria documented in clinical records. Pre-existing condition clauses rarely apply to fibroids after the Affordable Care Act (ACA) prohibited exclusions for pre-existing conditions in 2014.

Out-of-pocket costs vary; patients with employer-sponsored plans pay an average of $1,000–$5,000 per surgery depending on deductibles and coinsurance rates. Prior authorization requirements frequently delay approval for advanced treatments, with insurers requesting imaging evidence and failed conservative management attempts, according to YourInsurance.info (Your Insurance Info).

Medicaid covers most standard fibroid surgeries but may restrict access to newer minimally invasive options based on state guidelines and medical necessity reviews. Short-term health insurance plans often exclude coverage for chronic gynecological conditions like fibroids due to limited benefits and strict exclusions.

Denied claims can be appealed by submitting additional physician documentation proving that untreated fibroids cause significant pain or bleeding impacting daily activities.