Key takeaways:
Most health insurance plans cover medically necessary fibroid removal. But policyholders usually have to pay some out-of-pocket costs.
If you need help paying for fibroid removal surgery, you can look into Medicaid or a financing option, like a payment plan.
It’s important to review your treatment options and coverage before getting surgery.
You didn’t expect to hear the word “fibroids” at your gynecologist’s office today. Suddenly, you’re facing the prospect of fibroid removal, a treatment that surgically removes or shrinks these noncancerous growths in your uterus.
Fibroids are common. They affect 70% of white women and 80% of African American women by age 50. However, Black women are 3 times more likely to develop uterine fibroids compared to white women.
Without insurance, fibroid removal can cost anywhere from $8,900 to over $24,000, depending on the type of treatment you choose and the severity of your condition. Health insurance plans generally cover fibroid removal procedures that are medically necessary. Yet, as one small study found, Black women report disproportionate rates of being underinsured or uninsured.
If you need help paying for fibroid removal surgery, there may be ways to make it more affordable.
Does insurance cover fibroid removal?
In many cases, insurance will pay for uterine fibroid treatments if you’re experiencing symptoms related to the fibroids. But each health plan has rules for the specific procedures it will cover.
For instance, Cigna considers ultrasound-guided radiofrequency ablation a medically necessary fibroid treatment option if you have symptoms. But some health plans have stricter rules. Before covering a hysterectomy for fibroid removal, Blue Cross and Blue Shield of Minnesota requires patients to meet certain criteria, such as:
Experiencing symptoms like severe bleeding or issues with bowels, bladder, or sexual function
Undergoing imaging tests confirming the presence of fibroids
Having a sampling of the uterine lining to screen for cancer, based on age and menopause status
Before your gynecologist can schedule your fibroid removal, they may need to obtain a prior authorization from your health plan. During this process, the insurance company will review your case to decide if they consider your fibroid treatment medically necessary.
If you’re looking to enroll in a health plan to help cover fibroid treatment, ask about the following, as they may affect your out-of-pocket costs:
Deductible: A lower deductible means you'll pay less upfront, but your monthly premiums may be higher. Conversely, your premiums are usually lower if you have a high-deductible health plan. Choose a health plan with a deductible and premiums you can afford.
Network: If your preferred gynecologist or facility is not in network, you may pay more for the care you receive. Or, worse, your health plan may not pay for any of the services.
Restrictions: Some plans may only cover some types of fibroid treatments. Before enrolling, ask your gynecologist to review the plan’s rules to ensure the procedure you both agree on is covered.
Cost-sharing: After you meet your deductible, you may be responsible for copayments and coinsurance. Let's say your insurance is willing to cover $20,000 for a myomectomy (a surgery to remove fibroids that leaves the uterus intact), but you have a 20% coinsurance. You would be responsible for paying $4,000 as coinsurance.
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How to pay for fibroid removal surgery
If you have health insurance, and your fibroid removal procedure is deemed medically necessary, your insurance will likely cover some of the costs. Though, there’s a good chance you’ll pay for a share of the bill. And those out-of-pocket expenses can be significant.
Consider talking to your medical team about options to make fibroid removal surgery more affordable. Below are eight options you may want to discuss.
1. See if you qualify for Medicaid
Medicaid provides free or low-cost health coverage to millions of Americans. Eligibility is determined by state and income. It’s worth contacting your state's Medicaid office to find out if you qualify. If you do, Medicaid coverage can significantly reduce or eliminate your costs for fibroid removal.
2. Ask for discounts
If you don’t have insurance, ask your gynecologist or facility about self-pay discounts. You may be surprised at how willing they are to work with you, especially if you're paying cash upfront. The discounted rates are often significantly less than the list prices they bill insurance companies. So it doesn’t hurt to ask and try to negotiate a better price.
3. Sign up for marketplace insurance
Consider signing up for insurance through the Affordable Care Act (ACA) marketplace. You may qualify for subsidies, or discounts provided by the government to help make health insurance more affordable for individuals and families with lower incomes. Subsidies can reduce your monthly premiums and out-of-pocket costs.
Compare plans to find one that your gynecologist accepts, covers fibroid removal, and fits your budget.
4. Set up a payment plan
If you're concerned about paying your medical bills all at once, ask about a payment plan. With a payment plan, instead of having to pay the full amount upfront, you can spread out the costs over several monthly installments. This allows you to pay the bills gradually over time according to your budget, often with little or no interest. Contact your gynecologist or facility’s billing department for help setting up a payment plan.
5. Request a good faith estimate (GFE)
If you are self-pay, you can request a good faith estimate (GFE) from the facility where you’re having the procedure before scheduling it. This will give you a detailed breakdown of all the expected costs related to your procedure, helping you plan ahead and catch any potential billing errors later on. Pay close attention to the GFE because you can dispute the final bill if the charges exceed the estimated total by $400 or more.
6. Ask about financial assistance
Many hospitals have financial assistance available for patients who need help with medical bills. But you have to ask.
Nonprofit hospitals are required by law to offer charity care, thanks to the ACA. Some may use a sliding scale, which means your costs are based on your income. For-profit hospitals may offer grants. Contact your hospital’s billing office and ask for a financial assistance application.
7. Use tax-advantaged accounts
If you have a flexible spending account (FSA) or health savings account (HSA), you can use those pre-tax dollars to pay for some of your costs. You should reach out to your account custodian to confirm which expenses are HSA or FSA eligible. If you have an FSA, you should try to spend all the funds within the plan year, as any leftover money may be forfeited.
8. Consider a loan
Taking out a loan should be a last resort for paying medical bills. Loans mean you'll have to pay back the money you borrow, plus interest charges. However, if you have no other way to cover the cost of your fibroid removal, a loan might be an option.
Look for loans that offer a promotional no-interest-rate period. This allows you to potentially pay off the balance before any interest charges kick in. Alternatively, consider a loan with permanently low interest rates and no penalties for an early payoff.
Do fibroids need to be removed?
Not all fibroids need to be removed. Generally, if fibroids are not causing any symptoms or are small, your gynecologist may recommend monitoring them over time.
Researchers don’t know what causes fibroids to develop or why they’re more common in Black women, but they believe genetics and hormones — especially estrogen and progesterone — play a role. For example, fibroids tend to grow quickly during pregnancy, a time when a woman’s hormone levels increase. On the other hand, fibroids will often stop growing or even shrink during menopause, when estrogen levels drop.
There are treatments that help control bleeding and slow fibroid growth, Aldene Zeno, MD, a board-certified urogynecologist and owner of Essence Health and Urogynecology in Los Angeles, told GoodRx Health. These treatments, such as birth control pills and intrauterine devices (IUD), provide low doses of hormones to help regulate your body’s natural hormone levels.
“If we keep that circulating [hormone] level lower, then there may be less of that estrogen and progesterone to feed into the fibroids,” Zeno said.
Gonadotropin-releasing hormone agonists, like leuprolide (Lupron Depot), and gonadotropin-releasing hormone antagonists, like relugolix (Myfembree), are two other types of medications that help lessen heavy menstrual bleeding due to fibroids.
While these medications can be helpful with fibroids, they are not suitable for all cases. You may need treatment to remove or shrink fibroids if they are large, continuing to grow, or causing bothersome symptoms.
The bottom line
The cost of fibroid removal, which can range from $8,900 to over $24,000, can be a major concern. But it shouldn’t keep you from getting the treatment you need. There are ways to make fibroid treatment more affordable, including asking about financial assistance programs and negotiating fees. Research your options, ask questions if you don’t understand something, and speak up about any financial concerns.
Why trust our experts?
References
American College of Obstetricians and Gynecologists. (2022). Uterine fibroids.
Blue Cross and Blue Shield of Minnesota. (2023). Hysterectomy surgery for non-malignant conditions.
Cigna. (2023). Medical coverage policy: Ultrasound-guided radiofrequency ablation for uterine fibroids.
Eltoukhi, H. M., et al. (2013). The health disparities of uterine fibroid tumors for African American women: A public health issue. American Journal of Obstetrics and Gynecology.
HealthCare.gov. (n.d.). Medicaid & CHIP coverage.
Sengoba, K. S., et al. (2017). Racial/ethnic differences in women's experiences with symptomatic uterine fibroids: A qualitative assessment. Journal of Racial and Ethnic Health Disparities.
