You’ve been diagnosed with uterine fibroids. You’ve learned about uterine fibroid embolization (UFE)—a minimally invasive, non-surgical procedure that can shrink your fibroids and relieve your symptoms without a hysterectomy. You’re interested. But before you schedule anything, you have a practical question that matters as much as any clinical one:
Will my insurance cover it?
The short answer is: almost certainly yes. UFE is covered by the vast majority of insurance plans, including Medicare, Medicaid, and all major commercial carriers operating in Maryland, the District of Columbia, and Virginia. It is recognized by the American College of Obstetrics and Gynecology (ACOG) as a safe and effective treatment for symptomatic fibroids, and it has been performed in the United States for over 25 years.
But “covered” doesn’t always mean “simple.” Insurance coverage involves deductibles, co-pays, prior authorization requirements, and network considerations that can vary significantly from plan to plan. In this article, we’ll walk you through exactly what you need to know—and what you need to do—to navigate the insurance process for UFE in the DMV area.
UFE Is a Medically Recognized, Insurance-Covered Procedure
Let’s establish the baseline: UFE is not considered experimental or investigational. It is a well-established, FDA-recognized procedure with a reported success rate of approximately 95% according to the National Library of Medicine and over 90% patient satisfaction rates. Every major insurer in the Maryland, DC, and Virginia market covers UFE when it is performed for symptomatic uterine fibroids.
This includes Medicare (Parts A and B cover UFE when deemed medically necessary), Medicaid (covered in Maryland, DC, and Virginia), and all major commercial insurers operating in the region—such as CareFirst BlueCross BlueShield, Aetna, Cigna, UnitedHealthcare, Kaiser Permanente, Humana, and Amerigroup, among others.
Coverage is also typically available through TRICARE (for military families, many of whom are in the DMV area due to proximity to military installations), and through federal employee health benefit (FEHB) plans, which cover a large portion of the DC-area workforce.
The reason coverage is so broad is straightforward: UFE is less expensive than the surgical alternatives. Because it is minimally invasive and performed as an outpatient procedure, UFE avoids the costs associated with general anesthesia, overnight hospital stays, and extended post-operative care. Insurance companies have a financial incentive to cover UFE, and the clinical evidence supports its efficacy—a rare alignment that works in the patient’s favor.
Understanding Your Out-of-Pocket Costs
Even when UFE is covered, you will likely have some out-of-pocket expenses. These depend entirely on your specific insurance plan and may include your annual deductible (the amount you pay before insurance begins covering costs), co-insurance (a percentage of the procedure cost you pay after meeting your deductible, commonly 10–30%), co-pays (a fixed amount for specific services, such as specialist visits or facility fees), and out-of-pocket maximum (the most you’ll pay in a plan year; once reached, your insurer covers 100%).
One important advantage of UFE over surgical alternatives like hysterectomy or myomectomy is that UFE is an outpatient procedure, it typically involves lower facility fees. There’s no costly hospital overnight stay (which averages over $2,600 per night nationally), no general anesthesia fees, and fewer follow-up appointments. Even before insurance, the total cost of UFE is often comparable to or lower than surgical options. After insurance, many patients find that their out-of-pocket responsibility is manageable—sometimes equivalent to a specialist co-pay if they’ve already met their annual deductible.
Timing tip: If you’ve already met or are close to meeting your annual deductible (from other medical expenses earlier in the year), scheduling your UFE before your plan year resets can significantly reduce your out-of-pocket costs. Conversely, if you’re early in your plan year and haven’t met your deductible, it may be worth understanding exactly how much of the deductible the UFE procedure will satisfy.
Prior Authorization: What It Is and How to Handle It
Most insurance plans require prior authorization (sometimes called precertification or preauthorization) before they will cover UFE. This is standard for most medical procedures—not unique to UFE—and simply means your insurer wants to confirm that the procedure is medically necessary before approving payment.
Prior authorization typically requires documentation of your diagnosis (symptomatic uterine fibroids confirmed by imaging, usually pelvic ultrasound or MRI), evidence that conservative management has been attempted or considered (such as hormonal therapy, iron supplementation for anemia, or symptom management), and a treatment recommendation from your physician.
At Surgical Associates, our team handles the prior authorization process for you. When you schedule a consultation with Dr. Albert Chun, our insurance specialists will verify your benefits, submit the necessary documentation to your insurer, and follow up on the authorization. Most prior authorizations are processed within one to three weeks, though some insurers are faster.
If a prior authorization is denied—which is uncommon for UFE but does occasionally happen—you have the right to appeal. Insurers offer multiple levels of appeal, and your care team plays a critical role in submitting additional clinical documentation to support the medical necessity of the procedure. You also have the right to request an external, independent medical review of your case.
What to Have Ready When You Call Your Insurance Company
If you want to verify your UFE coverage before your first appointment, here’s a checklist of questions to ask your insurer and the information you’ll want to have on hand:
Information to gather before you call: Your insurance member ID and group number, the name and NPI (National Provider Identifier) of the provider (Dr. Albert Chun / Surgical Associates), the CPT procedure code for UFE (37243 for uterine artery embolization), the facility where the procedure will be performed, and your current deductible status (how much you’ve met so far this year).
Questions to ask your insurer:
Is uterine fibroid embolization (CPT code 37243) a covered benefit under my plan? Is Dr. Albert Chun / Surgical Associates considered an in-network provider? Is prior authorization required for UFE? If so, what documentation is needed and how long does the process typically take? Is prior authorization also required for the pre-procedural imaging (MRI or ultrasound)? Do I need a referral from my primary care physician or gynecologist? What is my current deductible, and how much have I met? What will my co-insurance or co-pay be for an outpatient interventional radiology procedure? What is my out-of-pocket maximum for the year?
Write down the reference number for your call. If there’s ever a discrepancy later, having a record of the call—including the date, time, and representative’s name—can be invaluable.
Insurance Considerations Specific to Maryland, DC, and Virginia
While most insurance principles are consistent nationally, there are a few regional considerations worth noting for patients in the DMV area:
Maryland. Maryland has its own unique hospital rate-setting system through the Health Services Cost Review Commission (HSCRC). This means hospital-based procedures in Maryland can sometimes have different cost structures than the same procedures performed in ambulatory surgery centers or office-based suites. UFE performed in an outpatient, non-hospital setting—like Surgical Associates’ facilities—often results in lower facility fees, which can translate to lower out-of-pocket costs for patients. Maryland Medicaid covers UFE.
District of Columbia. DC residents are covered by DC Medicaid (also called DC Healthcare Alliance for uninsured residents), and most ACA marketplace plans sold through DC Health Link cover UFE. The high concentration of federal employees in DC means many patients carry FEHB plans (such as Blue Cross Blue Shield Federal Employee Program, GEHA, or Mail Handlers), all of which typically cover UFE.
Virginia. Virginia expanded Medicaid in 2019, significantly broadening coverage for low-income residents. Virginia Medicaid covers UFE when medically necessary. For commercially insured patients, Virginia’s insurance market includes all major national carriers. Patients in Northern Virginia benefit from proximity to Surgical Associates’ Reston office, which provides convenient access without crossing into DC or Maryland.
UFE vs. Surgical Options: An Insurance Cost Comparison
When comparing UFE to hysterectomy or myomectomy from a cost perspective, UFE typically comes out ahead—for both the patient and the insurer:
UFE is an outpatient procedure. There are no overnight hospital charges, which can add thousands to the total bill. Recovery is faster, meaning fewer follow-up visits, fewer prescriptions, and less time away from work. There is no general anesthesia fee—UFE uses conscious sedation. The total procedure cost for UFE is generally lower than the hospital charges associated with hysterectomy or abdominal myomectomy.
For patients, this means lower co-insurance amounts (since the total charges are lower), fewer separate bills to manage (no separate hospital facility fee, anesthesiologist bill, etc.), and a faster return to work, reducing lost income during recovery.
What Happens If You Don’t Have Insurance
If you are uninsured or your plan does not cover UFE (which is increasingly rare), options still exist. Surgical Associates offers self-pay pricing and can discuss payment plans and financing options, including CareCredit. Because UFE is performed as an outpatient procedure, the self-pay cost is typically significantly lower than the self-pay cost for a hysterectomy or myomectomy, which require hospital admission.
How Surgical Associates Makes the Insurance Process Easier
We understand that navigating insurance can be stressful—especially when you’re already dealing with fibroid symptoms. At Surgical Associates, our dedicated insurance team works to make this process as smooth as possible.
When you schedule your initial consultation, our team will verify your insurance benefits and confirm your in-network status. If prior authorization is needed, we prepare and submit all clinical documentation on your behalf. We provide you with a clear estimate of your expected out-of-pocket costs before you commit to the procedure. If a claim is denied, we assist with the appeals process.
Dr. Albert Chun, our board-certified interventional radiologist with over 18 years of experience, performs UFE at our Camp Springs, Waldorf, Silver Spring (Maryland), Washington DC, and Reston (Virginia) locations. Our Women’s Health program is specifically designed to provide personalized, compassionate care for fibroid patients—from initial consultation through recovery.
The Bottom Line
UFE is covered by virtually all insurance plans in Maryland, DC, and Virginia—including Medicare, Medicaid, TRICARE, and every major commercial carrier. Prior authorization is usually required but is a routine process that your care team can manage. Because UFE is an outpatient procedure, out-of-pocket costs are often lower than for surgical alternatives.
The most important step you can take is to schedule a consultation. Once we know your specific insurance plan and clinical situation, we can give you a clear picture of both your treatment options and your expected costs. No woman should delay fibroid treatment because of uncertainty about insurance—and no woman should undergo a hysterectomy simply because she didn’t know UFE was an option.
Schedule a consultation or insurance verification: Call (240) 427-1630 or visit www.sacmd.com
Disclaimer: This article is for informational purposes only and does not constitute financial or medical advice. Insurance coverage, plan benefits, and out-of-pocket costs vary by individual plan. Always verify your specific coverage with your insurance provider. Surgical Associates accepts most major insurance plans; contact our office to confirm.
References:
- American College of Obstetrics and Gynecology (ACOG). UFE recognition as safe and effective treatment for symptomatic fibroids.
- National Library of Medicine (NIH). UFE success rates and patient outcomes.
- USA Fibroid Centers. Insurance coverage and UFE cost comparison data.
- Fibroid Fighters Foundation. UFE insurance FAQ and patient guidance.
- Preferred Fibroid and Vascular Center. Prior authorization guidance for UFE patients.
- Georgia Fibroids. UFE and insurance verification process.
Dr. Rahbar is an esteemed vascular surgeon at Surgical Associates, known for their exceptional contributions to the field of vascular surgery. As a board-certified vascular surgeon with over 20 years of invaluable experience, Dr. Rahbar is a respected authority in the medical community serving Camp Spring, Maryland and the whole community of Maryland. Their unwavering dedication to providing advanced care for patients with diseases of the arteries and veins has earned them a reputation for excellence. Dr. Rahbar’s work embodies a passion for precision and compassion, improving the lives of those they serve, one procedure at a time.