Insurance Coverage Survey Question Title * 1. Do you feel that all fibroid treatment options should be covered by health insurance? Yes No Optional - why or why not? Question Title * 2. Please RANK the following 5 factors you may consider when choosing a fibroid treatment procedure, from most important to you to least important to you (“5” being most important, “1” being least important): 1 2 3 4 5 length of recovery time/ability to return to normal activities 1 2 3 4 5 whether or not the procedure is covered by my insurance 1 2 3 4 5 whether or not the procedure involves surgery 1 2 3 4 5 likelihood of procedure to eliminate or reduce my fibroid symptoms 1 2 3 4 5 effect of this procedure on my fertility Question Title * 3. Would/did you intentionally select a treatment option for your fibroids because it is/was covered by your health insurance? Yes No Not sure Optional - why or why not? Question Title * 4. When considering a fibroid treatment option, if you learned that your preferred treatment option was NOT covered by your insurance, what would your next course of action be? I would appeal to my insurance provider to see if they will cover the procedure I would be forced to choose another treatment option I would pay for the procedure myself Not sure Question Title * 5. Which statement best describes your opinion on insurance coverage for fibroid treatment? It is my right to have the best treatment procedure for me (as determined by me and my doctor) and it should be fully covered by my insurance. Who wants to deal with insurance coverage? If my preferred treatment plan is not covered, I will just select another. I am appalled that some treatment options for fibroids are not covered by insurance. My preference is to select a treatment procedure that enables me to avoid hassling with my insurance company. Other (please specify) Question Title * 6. Which of the following treatment options have you discussed with your doctor at any time? (Check all that apply.) Hysterectomy Myomectomy Focused ultrasound Endometrial ablation Uterine artery embolization/uterine fibroid embolization Medical therapy (such as depo-lupron, levonorgestrel intrauterine system, birth control pills) "Watchful waiting" (allowing time to pass before medical intervention or therapy is used) Other: Question Title * 7. If you have NOT been treated for your fibroids, please skip to Question #8. If you have been treated for your fibroids, please check which treatment(s) you have had below and whether or not it was covered by your insurance. Yes, it was covered by insurance No, it wasn't covered by insurance Hysterectomy Hysterectomy Yes, it was covered by insurance Hysterectomy No, it wasn't covered by insurance Myomectomy Myomectomy Yes, it was covered by insurance Myomectomy No, it wasn't covered by insurance Focused ultrasound Focused ultrasound Yes, it was covered by insurance Focused ultrasound No, it wasn't covered by insurance Endometrial ablation Endometrial ablation Yes, it was covered by insurance Endometrial ablation No, it wasn't covered by insurance Uterine artery embolization/uterine fibroid embolization Uterine artery embolization/uterine fibroid embolization Yes, it was covered by insurance Uterine artery embolization/uterine fibroid embolization No, it wasn't covered by insurance Medical therapy (such as depo-lupron, levonorgestrel intrauterine system, birth control pills) Medical therapy (such as depo-lupron, levonorgestrel intrauterine system, birth control pills) Yes, it was covered by insurance Medical therapy (such as depo-lupron, levonorgestrel intrauterine system, birth control pills) No, it wasn't covered by insurance Other (please specify and note whether insurance coverage was provided) Question Title * 8. Please check which statement(s) below apply to your knowledge and experience with focused ultrasound to treat your fibroids. I have never heard of focused ultrasound. I have discussed focused ultrasound with my doctor but I am not a candidate. I considered focused ultrasound to treat my fibroids but it was not covered by my insurance so I did not have the procedure. I was treated with focused ultrasound. Other: Question Title * 9. How much would you be willing to pay out of pocket (if necessary) for the treatment option that you and your doctor determined was the best option for you? $2,000 (typical deductible) $5,000 More than $5,000 I do not have insurance and/or I would not be willing/able to pay anything out of pocket Other: Question Title * 10. Most common treatments for uterine fibroids are covered by insurance. Newer options such as focused ultrasound, which has been available to U.S. patients since 2004, may be more effective for some women. Focused ultrasound is a noninvasive, no-incision option with a quick recovery time that is still considered "experimental" and is not yet covered by insurance.Would you be interested in signing a petition that Fibroid Relief will send to your state insurance commissioner asking for better insurance coverage of fibroid treatments such as focused ultrasound? Yes No Not Sure If yes, please provide name and email address/contact info: Done