A surgeon says her patient with stage 4 endometriosis needed a hysterectomy, but the insurer denied it and suggested birth control instead

A surgeon recently had a peer-to-peer call after a patient’s insurance denied a medically necessary hysterectomy meant to treat stage 4 endometriosis. In an Instagram post with tens of thousands of views, Dr. Sadikah Behbehani (dr.sadikahbehbehani) explained that while the call was successful, it was frustrating.

According to Behbehani, the patient had been suffering from pain and bowel symptoms for many years. She said that in an ultrasound she performed herself, she could see the endometriosis, with the patient’s bowel and ovaries attached to the back of her uterus. Since the patient had no desire for future fertility, the two decided on a hysterectomy. However, the insurance provider denied the claim, insisting the patient try birth control or Lupron first.

She scheduled the peer-to-peer call and, fortunately, spoke to an OB-GYN. Still, Behbehani had to explain that “this disease is not going to go away with any medication.” She noted that her patient is 44 and had already used birth control, and said that putting her into medically induced menopause via Lupron would bring its own risks and wouldn’t treat the “rock-solid” inflammatory deposits created by the disease.

Behbehani also had to defend her diagnostic methods

Endometriosis can be hard to see, and thus easy to misdiagnose. In this case, however, Behbehani said it was clearly visible on the ultrasound. Despite this, she said she had to argue against a diagnostic laparoscopy, noting that it would be unethical to force the patient to undergo multiple surgeries. Eventually, the reviewer approved the case. Behbehani told her viewers that the doctor was “very understanding,” adding, “I think she just had to go through her checklist of questions.”

Mayo Clinic describes endometriosis as an often painful condition in which tissue similar to the inner lining of the uterus grows outside the uterus. It frequently affects the ovaries, fallopian tubes, and pelvic lining. This tissue thickens, breaks down, and bleeds with each menstrual cycle, but since it has nowhere to go, it can lead to irritation, scar tissue, and adhesions that cause organs to stick together.

Many of Behbehani’s viewers were outraged by the barriers she and her patient faced. One user pointed out that “Hormone pills do NOT treat Endometriosis,” though they can help with symptoms. Another said the insurance tactic is known as “Delay, Deny, Defend” in the commercial insurance market. Others criticized doctors who work as insurance reviewers, saying they become obstacles to patient care.

Behbehani was most frustrated that insurers could impose a standard order of treatment. In the caption, she wrote, “Treatment should be individualized, evidence-based, and decided between the patient and their surgeon.” She also added, “Patients deserve options, not obstacles. Enough is enough.”

Attack of the Fanboy was unable to independently verify the insurer’s side of the story, as this account originates solely from Behbehani’s Instagram post.