July 27, 1999 ....... (retyped by Nancy Lee for posting, names/IDs edited, on 9/1/99)
Nancy R. Lee
(city, state, zip)
Re: Nancy Lee
Identification No.: (xxxxxxxxxx)
Dear Ms. Lee:
Thank you for taking the time to share your concerns about your request for Intergroup to approve a uterine artery embolization for treatment of uterine fibroids and for your patience during Intergroups review of your request.
The Committee would like to thank you for helping to coordinate Pam, your patient advocate, and Dr. (my IR) in presenting your case. In addition, one of our Medical Directors contacted a Gynocology Specialist at the University of Arizona regarding the procedure. Following the presentation on July 27, 1999 the Appeals Committee thourougly (sic) reviewed all of the issues and determined to uphold the denial because uterine artery embolization for treatment of uterine fibroids, according to criteria outlined in Foundation Health Medical Policy, is considered an Experimental/Investigational procedure.
For further information regarding this denial, please refer to your State of Arizona Evidence of Coverage, Section, Exclusions and Limitations, it states (sic); Experimental and/or Investigational medical, surgical or other experimental health care procedure, services or supplies. Experimental and/or Investigational procedures, services or supplies are those which, in the judgement of Intergroup:
* are in a testing stage or in field trials on animals or humans;
* Do not have the required final federal regulatory approval for commercial distribution for the specific indications and methods of use assessed;
* are not in accordance with generally accepted standards of medical practice; or
* have not yet been shown to be consistently effective for the diagnosis or treatment of the Members condition.