FUNDING OF YOUR MR-GUIDED FOCUSED ULTRASOUND PROCEDURE

At the present time, Focused Ultrasound is only available on a private basis, and is not an NHS treatment. What this means is that an eligible patient may not readily receive funding from their local PCT for this procedure.  This is because the procedure is still being reviewed by the National Institute of Clinical Excellence (NICE) (www.nice.org.uk).  Efforts are ongoing to secure favourable approval by NICE.

There is however an option to apply to the local PCT for “special cases” funding of the procedure.

Each PCT has a set amount of money each year that they set aside for special cases - to provide funding for procedures not covered by the NHS but where there is a clinical need for that procedure.  Applications are considered on a clinical need basis.  They do not take into consideration a lack of ability to fund the procedure.  Examples of special cases circumstances include clinical, psychological or other reasons why a particular patient cannot undergo other alternative fibroid treatments which are available on the NHS (such as hysterectomy, myomectomy or uterine artery embolisation).  This might include:

-          Previous surgical trauma.

-          Co-existing medical conditions which would make a surgical procedure or subsequent                        recovery difficult / dangerous.
-          Nulliparous and of child-bearing age.
-          Difficulty in recovering from an operation due to need to look after young children,
no support at home etc.
-          Past failed attempts at fibroid treatment.

It is important to be aware however that even with the presence of special cases circumstances, some PCT’s will refuse to fund treatments, until NICE approval has been achieved. We would however encourage patients not to be put off by the process as the more applications the PCT receives, the more likely they are to eventually cover the procedure.

The Process

The first step is to ask your GP to refer you to a treatment centre for a consultation in the fibroid clinic with a gynaecologist. There the gynaecologist will take your medical history and examine you and make an assessment for your clinical eligibility to proceed with treatment. That is to make sure you have no contra-indications for treatment including; longitudinal or high transverse abdominal scars, pacemakers and other implantable devices that make it dangerous to have an MR scan.

Once the gynaecologist has deemed you as a potential candidate for treatment, an MRI scan will be organised for you. This determines if technically your fibroid can be treated with Focused Ultrasound. Once a decision has been made by the physicians (gynaecologist and radiologist) they will start the formal application process to the PCT. Each PCT is different in terms of their application processes and waiting times.

Generally, the special cases committee will sit every six to eight weeks to review received applications.  Funding is very limited and it is important to make a strong case, you may be asked to give a personal view on how your symptoms are affecting your quality of life, to further strengthen your case.  As fibroids are benign tumours, the clinical need for using the PCT’s resources will be limited unless there is a clear restriction on quality of life (severe symptoms for example).

Once a decision has been made regarding the funding, both you and your GP will be informed, and a treatment date can be scheduled. If funding is declined, your gynaecologist will discuss suitable treatment alternatives with you.

If you have medical insurance

Similarly, Focused Ultrasound is not currently funded by insurance companies for the same reason. Although a few insurers have funded some treatments for patients, each case is dealt with on an individual basis. We are happy to provide your insurers with supportive documentation as required.

Self pay

Alternatively you may fund the procedure yourself. You will still require to go through the same suitability assessment procedure.