March 12, 1999 .... (retyped for posting by Nancy Lee on 9/1/99, names and ID’s edited)

Attn: Intergroup Medical Directors
c/o (group liaison person), Group Insurance
Intergroup of Arizona, Inc.
2800 N. 44th Street, Suite 900
Phoenix, AZ 85008-1553
FAX: (602) 542-4744

Re: Patient: Nancy R. Lee
Policy: Member ID#: (xxxxxxxxx)
Insured: Nancy R. Lee
Reference #: (xxxxxxxxx)

Dear Intergroup Medical Directors,

I am writing to appeal Intergroup’s denial of my request for a referral to Scottsdale Healthcare, darted February 18, 1999, for Uterine Artery Embolization to treat uterine fibroids. According to the letter of denial, Uterine Artery Embolization, or UAE, is regarded by Intergroup to be experimental.

I have asked my gynecologist, Dr. (my gyne), to write you concerning my condition and the need for prompt treatment. I have also asked Dr. (my IR), the interventional radiologist to whom Dr. (my IR) referred me, to send a letter explaining the procedure and its benefits.

Please find my arguments in support of Uterine Artery Embolization first summarized and then detailed below. To summarize more briefly, UAE has more advantages and fewer disadvantages for both the patient and their employer than major surgery, and that, while newer than other treatments, it is not experimental in the sense of clinical trials, but rather has earned rapid acceptance due to its obvious practicality.

Because my discomfort due to large uterine fibroids is disrupting my work and personal life, I hope this appeal is resolved quickly. I am experiencing substantial discomfort during much of the month, with cramping, pressure, backache, a burning sensation in the abdomen, and very heavy menstrual bleeding that limits my mobility. I have to take iron for anemia. Non-prescription painkillers have little effect on the mid-cycle discomfort of cramping, pressure and backache. It is also somewhat difficult to urinate due to the position and size of my uterus.

While awaiting resolution of this appeal, I must consider hormone treatment to induce temporary menopause. I prefer not to do so. However, my discomfort has grown to the point that it often makes work difficult since my job involves a lot of sitting, which is particularly distressing.

If this appeal is denied, I plan to appeal to the Arizona State University Benefits Office and the Arizona State Department of Insurance. The purpose of Arizona State’s health benefits is to keep people healthy and at work - not at home recovering from major surgery when there’s a proven, practical alternative.

Summary of points in favor of UAE

UAE is more practical than the alternatives

Uterine artery embolization is less invasive, less risky, and more practical for the patient and the patient’s employer than either hysterectomy or myomectomy.

UAE providers in Arizona

Uterine artery embolization is rapidly becoming available both nationally and in Arizona. A partial list of interventional radiologists who perform the procedure in Arizona includes:

Some other doctors and hospitals who perform UAE

Bruce McLucas, M.D., Assistant Clinical Professor, UCLA School of Medicine
Scott C. Goodwin, M.D., Chief of Vascular and Interventional Radiology, UCLA Medical Center, (310) 794-6645, (310) 208-2442

James B. Spies, M.D., Georgetown Interventional Radiology, Georgetown University Hospital, (202) 784-3420

Corlos Forcade, M.D. (IR), Fibroid Embolization Center of the NYUnited Hospital Medical Center, Port Chester, NY, (914) 934-3178

Francis L. Hutchins, Jr, M.D. (Ob/Gyn) and Robert L. Worthington-Kirsch, M.D. (IR)
Bala Cynwyd, PA, (610) 667-4577

Steven Smith, M.D. (IR), La Grange Memorial Hospital, LaGrange, IL,
(708) 579-4292

Christ Hospital and Medical Center, 1-800-323-8622

Robert Mals, M.D., Director: Vascular-Interventional Radiology, Department of Radiology, NorthShore Medical Center - Salem Hospital, Salem, MA,
(978) 741-1200 ext 4420

Warren Schwarz, M.D. (IR) and Grant Price, M.D. (IR)
Associated Radiologists, P.A., Plainfield, NJ, (908) 668-3088

George A. Fueredi, M.D. (IR), Memorial Hospital of Burlington, Aurora Health Care, Burlington, WI, (414) 763-0362

Insurers who support UAE

I am aware that the following insurance companies have reimbursed Scottsdale Healthcare for the procedure:
Obviously this is just a partial list, since many other doctors and hospitals are providing the procedure.

I trust that this appeal will be resolved quickly and positively.

Sincerely yours,
Nancy R. Lee


Uterine artery embolization for the treatment of uterine fibroids. Curr Opin Obstet Gynecol 1998 Aug;10(4):315-20 (ISSN: 1040-872X)

Transarterial embolization of the uterine arteries: patient reactions and effects on uterine vasculature. Acta Obstet Gynecol Scand 1998 Mar;77(3):334-40 (ISSN: 0001-6349)

Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 1997 Jul-Aug;8(4):517-26 (ISSN: 1051-0443)

Uterine artery embolization: an underused method of controlling pelvic hemorrhage. Am J Obstet Gynecol 1997 Apr;176(4):938-48 (ISSN: 0002-9378)

Transcatheter uterine artery embolisation to treat large uterine fibroids. Br J Obstet Gynaecol 1998 Feb;105(2):235-40 (ISSN: 0306-5456)

Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response. Radiology 1998 Sep;208(3):625-9 (ISSN: 0033-8419)

Value of Preoperative Embolization of Uterine Fibroma: Report of a Multicenter Series of 31 Cases. Contraception, Fertilitie, Sexualitie 1995; 23(1):45-49

Arterial Embolisation to Treat Uterine Myomata. Lancet 1995: 346:671-672

Obstetric Embolotherapy: Effect on Menses and Pregnancy. Radiology 1996; 201:179