Endometriosis means the presence of endometrial tissue (normal lining of the uterus) outside the uterus, usually in the pelvic cavity.
In OneCare's policy definition, 'Endometriosis (severe requiring surgical intervention)' requires the surgical mobilisation of the rectum, excision of deposits from the rectum and other parts of the pelvis, and freeing of adhesions. Mild and moderate endometriosis and adenomyosis are excluded.
The requirement of surgery as a treatment is used to identify people diagnosed with endometriosis who will be significantly impacted by their disease, as they will need most support. Karina's claims consultant, Fred, noticed that Karina’s doctor had not advised surgery as a treatment for Karina – yet she was clearly suffering significant impairment from her condition. Fred investigated further.