PAYERS ARE DENYING TREATMENT OF PELVIC VENOUS DISEASE & PELVIC CONGESTION SYNDROME
TIME TO TAKE ACTION!
Payer Denials: As insurance companies are creating/updating their medical policies for the treatment of pelvic venous disease (PeVD), many are inappropriately denying coverage. Some policies are citing lack of data and/or claiming that the treatment is investigational.
Evidence of Gender Bias: Testicular vein embolization has been typically covered while the analogous disease in women is not. The result of denying coverage could sentence a patient to a lifetime of suffering for women. Ongoing chronic pelvic pain will lead to severe lifestyle-limiting changes. Therefore, is time to put our patient’s first by getting these policies reversed.
Interventional Treatment is Viable: According to The Society of Interventional Radiology (SIR), Gonadal vein embolization’s have been proven to be both safe and effective in both men and women because they are minimally invasive image-guided procedures with very few complications.
SIR Carrier Advocacy Workgroup Letter: The SIR Carrier Advocacy Workgroup focuses on insurance coverage recommendations to make sure they are up to date with current research and literature. Policies related to vascular and interventional radiology are periodically reviewed and evaluated by experts in the field. While reviewing policies that identified non-coverage for the treatment of PeVD, it became evident they were flawed. The SIR’s Carrier Advocacy Workgroup created this letter – SIR Letter for PeVD All Payers 2021 – that provides medical necessity, supporting evidence of the safety, and durability of this treatment.
Act Now to Save Image-Guided PeVD and PCS Treatment
- Contact your payers and request that they cover venous embolization for the treatment of PeVD for both men and women.
- Include the SIR Carrier Advocacy Workgroup Letter to support the justification for the payer to allow coverage for treatment of pelvic congestion syndrome by embolization.
- Just fill in the name and address of the payor.
- If possible, include the name of the Medical Director.
Finally, we recommend that you provide a brief cover letter using your letterhead. If you need assistance in writing a cover letter, here is an example of what you could include:
“I recently learned that your medical policy does not cover embolization to treat pelvic congestion syndrome. When my patients present with clinical signs and symptoms along with imaging findings it becomes a high priority for me to help them. The best treatment is ovarian vein embolization which has better clinical outcomes, a faster recovery time, and lower rates of repeated interventions in comparison to other treatments.
The Society of Interventional Radiology (SIR) is a professional medical association that represents physicians that are practicing in the specialty of vascular and interventional radiology. Please review the latest evidence they have gathered in support of covering this very important procedure.
Please change your policy to cover this treatment. This is a safe, efficient and relatively low-cost solution to this prevalent condition, and it can prevent a lifetime of suffering.”
Please act on this today!
For questions or assistance, please feel free to contact:
StreamlineMD: Wendy Block – firstname.lastname@example.org