I recently had an encounter with United Healthcare that initially resulted in a denial of a request to treat one of their patients with UPJ stenosis (partial obstruction of the drainage leading from the kidney to the bladder) with a robotic repair of the condition. The denial was initially based on the perception that such surgery was “experimental” and not a generally accepted form of treatment. After nearly two months of back and forth, I have approval to do the procedure and I believe I have convinced United Health to accept the procedure generally for all its subscribers. I have posted below several references to articles that I forwarded to the medical director in the course of our discussions. Most pyeloplasties are done in children and you can see that the articles reflect that, although my patient was an adult. Perhaps they will be of help to someone else in a similar situation.
Robotic Assisted Laparoscopic Pyeloplasty In Children, Atug F, Woods M, Burgess SV, Castle EP, Thomas R, The Journal of Urology, October 2005 (Vol. 174, Issue 4 (Part 1), Pages 1440-1442
Robot Assisted Pyeloplasty in the Infant—Lessons Learned, Kutikov A, Nguyen M, Guzzo T, Canter D, Casale P, The Journal of Urology, November 2006 (Vol. 176, Issue 5, Pages 2237-2240
Pediatric Robot Assisted Laparoscopic Dismembered Pyeloplasty, Comparison With a Cohort of Open Surgery, Lee RS, Retik AB, Borer JG, Peters C., The Journal of Urology, February 2006 (Vol. 175, Issue 2, Pages 683-687
Survey of Residency Training in Laparoscopic and Robotic Surgery, Duchene DA, Moinzadeh A, Gill IS, Clayman RV, Winfield HN, The Journal of Urology, November 2006 (Vol. 176, Issue 5, Pages 2158-2167)
Minimally Invasive Surgical Management of Ureteropelvic Junction Obstruction: Laparoscopic and Robot-Assisted Laparoscopic Pyeloplasty, Clayman RV, The Journal of Urology, March 2005 (Vol. 173, Issue 3, Page 868