The UnitedHealth Group's campus in Minnetonka, Minn. (Jim Mone/AP Photo)
The UnitedHealth Group's campus in Minnetonka, Minn. (Jim Mone/AP Photo)
The UnitedHealth Group’s campus in Minnetonka, Minn. (Jim Mone/AP Photo)

NEW YORK (AP) — UnitedHealth, the largest U.S. health insurer, said Thursday it is tightening its coverage rules on hysterectomies.

The company says it will require health care professionals and facilities and providers to notify it in advance if they plan to perform some types of hysterectomies. UnitedHealth said in a notice to providers it won’t approve the procedure if it concludes that the operation isn’t medically necessary.

UnitedHealth Group Inc. says the changes are based on recommendations from the American Congress of Obstetricians and Gynecologists, which said vaginal hysterectomies are recommended over abdominal procedures and “keyhole” laparoscopic procedures. It quoted from recommendations ACOG issued in 2009 that said vaginal procedures are associated with better outcomes and fewer complications.

The Minnetonka, Minnesota-based company said the guidelines will take effect April 6. Vaginal hysterectomies performed on an outpatient basis won’t have to be approved ahead of time.

Hysterectomy is the surgical removal of the uterus, and the procedure is used as a treatment for a variety of conditions including severe endometriosis, chronic pelvic pain, and some cancers. Based on reports from the early 2000s, the Centers for Disease Control say about 600,000 hysterectomies are performed every year in the U.S.

The uterus can be removed through the vagina or abdomen, and surgeons sometimes use laparoscopic tools to allow for a less invasive operation that involves only a few small incisions. The standard abdominal procedure involves a larger incision and is associated with longer recovery time.

In November the Food and Drug Administration issued a stronger warning on a once-popular device used in laparoscopic hysterectomies, saying the product shouldn’t be used in the “vast majority” of cases because it can spread undetected cancers. The device is called a laparoscopic power morcellator, and it is used to remove uterine fibroids or the entire uterus in less-invasive surgeries.

Robotic surgical systems are also sometimes used in the procedures, but in 2013 ACOG said those tools shouldn’t be a first or even second choice for most women. The group said vaginal operations allow women to leave the hospital just as quickly and don’t cost nearly as much.

The American Congress of Obstetricians and Gynecologists is the largest U.S. group of OB/GYNs.

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