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.

• Uterine artery embolization is less invasive, more practical and less risky than either hysterectomy or myomectomy.
  
  
• Because of the excellent results obtained with UAE, this procedure is being performed all over the country, including Arizona. It is newer than other fibroid treatments such as hysterectomy, but it is not “experimental”.
  
  
• Other insurance companies have recognized the benefits of this procedure and have approved and paid for its use.
  

• Far less time spent in the hospital: UAE is an outpatient procedure with a hospital stay of less than 24 hours. Abdominal hysterectomy typically involves a 3-4 day hospital stay.
  
• Far shorter recovery time (an order of magnitude): recovery from UAE ranges from 2-5 days. Recovery from abdominal hysterectomy ranges from 4-6 weeks.
  
• Far less time lost from work: one may return to work in a few days or a week, rather than in a month or more. I would be at my desk and productive in a few days, rather than requiring my employer to compensate me for sick and vacation time.
  
• Time lost from work is particularly important to my employer at this point, since I’m a computer programmer currently working on the Y2K project for ASU’s Administrative Computing, and a prolonged absence could negatively impact the project.
  
• Because UAE is far less invasive than hysterectomy or myomectomy, it’s less risky. There’s little or no blood loss from two one-eighth-inch incisions. There’s less risk of contracting an infection while hospitalized. Because there’s less tissue trauma, there are no subsequent problems from adhesions.
  
• Unlike hysterectomies, this procedure only targets the problem - fibroids- rather than a major organ. Unlike myomectomies, it has a high success rate over time, with a very low complication rate and much lower risk. (Please see attached references.)
  

• William B. Crenshaw, M.D., Scottsdale Healthcare, Osborn and Shea, Scottsdale, AZ (602) 425-5000
  
• Jonathan M. Levy, M.D., Scottsdale Healthcare, Scottsdale, AZ (602) 425-5000
  
• Cordell A. Esplin, M.D., Good Samaritan Medical Center, Phoenix, AZ (602) 239-4600
  
• Aubrey M. Palestrant, M.D., Good Samaritan Medical Center, Phoenix, AZ (602) 239-4600
  
• Stuart N. Pollack, M.D., Thunderbird Samaritan Medical Center, Phoenix, AZ (602) 588-5810
  
• Julie M. Zaetta, M.D., University Medical Center, Tucson, AZ (520) 626-6794
  
• Aaron Kromhout, M.D., Good Samaritan Medical Center, Phoenix, AZ (602) 239-4344
  

• UCLA Medical Group
  

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

• Georgetown University Medical Center
  

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

• New York United Hospital Medical Center
  

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

• The Hutchins Institute for Women's Health at Roxborough Memorial Hospital
  

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

• LaGrange Memorial Hospital
  

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

• Advocate Health Care, a medical conglomerate in the Chicago area
  

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

• NorthShore Medical Center - Salem Hospital
  

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

• Associated Radiologists, P.A.
  

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

• Memorial Hospital of Burlington, Aurora Health Care/Sinai Samaritan Medical Center
  

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

• Blue Cross/Blue Shield
  
• Aetna
  
• CNA
  
• United Healthcare
  
• Pacific Care