UK

Funding of Your MR-guided Focused Ultrasound Procedure in the UK

Focused Ultrasound (FUS) can be funded either through individual Primary Care Trust (PCT) applications, insurance, or privately. In every case the patient will need to be assessed for suitability by being referred to the Fibroid Clinic, at St Mary’s Hospital in London, as detailed below.

Currently, FUS is not routinely paid for by  the NHS. It is however a treatment option that should be discussed with you at your specialist appointment.

The National Institute for Health and Clinical Excellence (NICE)  has recently issued a new review of focused ultrasound for the treatment of uterine fibroids which states that this procedure is safe enough and works well enough for use with the NHS. As a result of this, efforts are currently being made to add the treatment to service development agreements with the PCTs, so that it can be routinely funded. Meanwhile, funding can be obtained on a case-by-case basis.

The MR Therapy Centre in St Mary’s Hospital in London is the only unit in the UK to offer this treatment. They are also able to help source funding for suitable patients through applying for Exceptional Funding to the local PCT or PCT cluster. This application is made on a patient-by-patient basis, and the PCT takes into account any exceptional circumstances that make other fibroid treatments, which are available on the NHS (such as hysterectomy, myomectomy or uterine artery embolisation) unsuitable for the patient. The MR Therapy Centre team at St Mary’s Hospital will make the application on your behalf and they have a good track record of acceptance.

Of course, the MR Therapy Centre cannot be held accountable for the PCT’s decision; however they do put forward a case for exceptionality based on clinical assessment and patient information provided.

Exceptional circumstances that the PCTs will consider include:

  • Previous surgical trauma.
  • Co-existing medical conditions which would make a surgical procedure or subsequent recovery difficult / dangerous.
  • Past failed attempts at fibroid treatment.

Unfortunately, desire to preserve fertility is not given as much importance by some PCTs.

It is important to be aware however that even in the presence of exceptional circumstances, some PCTs will refuse to fund treatments. 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.

Referral Procedure for FUS

To be considered for FUS, you should ask your GP or local gynaecologist to refer you to the  National Fibroid Clinicat St Mary’s Hospital in London. 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 MRI scan. Once the gynaecologist has deemed you as a suitable potential candidate for the FUS treatment, an MRI scan will be organised for you. The results of this and of your consultation are discussed by several specialists at a weekly multidiscliplinary team meeting. This team uses their experience and expertise to decide if your fibroid is appropriate for  Focused Ultrasound treatment. Once a decision has been made by the multidisciplinary team, if you are suitable for FUS and wish to apply for funding, the team at MR Therapy Centre will start the formal application process to the PCT. Each PCT is different in terms of their application processes and waiting times, but a 6-8 week waiting time is to be expected before a decision is reached.

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

Aviva will fund all requests for FUS, so if you are insured with Aviva, and wish to undergo the treatment, please contact the insurer and MR Therapy at St Mary’s to set proceedings in motion.

Other insurance companies will fund FUS on a case-by-case basis, and certain restrictions will apply, which you will need to be sure of before agreeing to treatment. Historically however, Bupahas also funded the treatment on several occasions, so if you are insured with Bupa, we would encourage you to explore this option.

Please note that most insurance companies will not fund treatments for pre-existing conditions –i.e.  a condition that you were aware of before joining the insurance scheme.

MR Therapy at St Mary’s will help with the application as required, and they are happy to provide your insurers with supportive documentation.

Self Pay

Alternatively you may fund the procedure yourself. You will still need to be assessed by a gynaecologist, whether privately or on the NHS, and reviewed at the multidisciplinary team meeting. The MR Therapy Centre at St Mary’s can provide further information on this.