ACC recently released new cover guidance for pelvic surgical mesh injuries.
The guidance explains ACC’s approach to making decisions on pelvic mesh injuries and understanding when it may be beneficial to submit a treatment injury claim.
Based on the new guidance, ACC is giving people with previously declined surgical mesh claims the opportunity to have their cover decision reassessed at their request. This applies to any surgical mesh claim declined prior to 28 October 2020, regardless of the type of mesh the person has.
“We know these injuries have had a significant impact on people, and we want to provide support where we can. We encourage clinicians to discuss this with patients who may benefit from having their claim reassessed,” says ACC’s Chief Clinical Officer, Dr John Robson (pictured left)
“To develop the guidance, we worked with an external advisory group including experts in urology, obstetrics and gynaecology, surgery, and pain, who were nominated by their professional bodies.
“The group considered the latest medical evidence and understanding of mesh injuries, and how this applies in the ACC context, as well as themes identified in past ACC claims.”
As John explained, the new guidance means that:
- Where there is clear evidence of mesh erosion/extrusion, specific nerve damage, or surgical error, ACC is likely to accept the claim.
- In cases where there is evidence of symptoms such as pain or sexual dysfunction, but no clear diagnosis of a physical injury causing the symptoms ACC can support further assessment to investigate if there is a physical injury. This new medical evidence may support the link to mesh injury.
- Age, menopause and/or use of oestrogen therapy aren’t relevant to the cause of surgical mesh injuries. Claims are unlikely to be declined because of these reasons alone.
Reassessment of declined surgical mesh claims
ACC will make this information publicly available through advocacy groups, health professionals, its website, and other public channels in late October.
ACC will begin accepting reassessment requests from 28 October 2020 and is advising people to contact its dedicated team on 0800 735 566 or email email@example.com, or visit their GP to discuss the opportunity.
More information about the reassessment process, including case examples of claims that may be impacted is available on ACC’s website.
GPs can also contact ACC’s dedicated reassessment team on 0800 735 566 or email firstname.lastname@example.org.