Aetna: Stop Failing Patients in Pain
  • Petitioned Aetna (health insurance company)

This petition was delivered to:

Cynthia B. Michener, Public Relations Manager
Aetna (health insurance company)
Thomas F. Cowhey, Vice President, Investor Relations Aetna Inc
Aetna (health insurance company)
Executive Complaints and Resolutions Department
Aetna Executive Complaints and resolutions Department

Aetna: Stop Failing Patients in Pain

    1. Ryan Carroll
    2. Petition by

      Ryan Carroll

      Bealeton, VA

  1.  
  2.   
January 2012

Victory

Ryan Carroll, a mother of four young children, has been suffering from a debilitating, painful hip condition known as FAI. Without a surgery that relieves the condition, this would only get worse and she could wind up needing a hip replacement.

Even though other major insurers cover this surgery and call it "medically necessary", Ryan's insurer—Aetna— had a policy that claimed the surgery was "experimental." They denied her coverage. Out of pocket, the surgery cost $50,000 and Ryan's husband would have had to quit his job to switch insurers if they couldn't get her surgery covered.

Ryan launched a petition on Change.org asking Aetna to change its unfair and unjust policy. She recruited more than 1,000 signatures—many from people who were also denied by Aetna for this same condition.

Just before Christmas, in the middle of her second appeal, Ryan got a call that Aetna would cover her surgery. And, then, just before New Year's, on 12/30/11, Aetna changed its entire policy, even though it had not been technically scheduled to review the policy again for another year.

Now, because of Ryan's campaign, Aetna's policy now acknowledges the surgery for FAI is "medically necessary."


This is a big victory for Ryan and for others who suffer from FAI.

"This petition and the signatures and comments of those who supported it have enabled me to look forward to a pain free future. That is amazing. Even more amazing is the knowledge that I may have helped many others in the same situation. Thank you, AETNA, for listening and doing the right thing," said Ryan Carroll.

I’ve lived in pain since I was 17, when I first felt discomfort in my hip joints. It was such a relief when, last year, a doctor finally diagnosed me with FAI (Femoroacetabular Impingement), an arthritis-like hip condition that affects young people. Luckily, it is treatable by surgery.

My relief was short-lived. My health insurer Aetna has since twice refused to cover my surgery. Aetna claims this surgery is not “medically necessary.”

Not medically necessary? With this surgery, my life would hopefully be normal again. I might even be able to play with my four beautiful children without pain. However, left untreated, my condition is degenerative and will only get worse.

My husband is a hard-working war veteran, and our family is fortunate to be insured by his current employer—our fortune shouldn’t end there.

Aetna should cover this much-needed procedure. Other major insurers, including Blue Cross Blue Shield, Medicare, CIGNA and United HealthCare, all cover surgery for people like me and explicitly acknowledge it is “medically necessary.” Similarly, by issuing billing codes, the American Medical Association supports medical efficacy of this procedure.

Big insurance companies, including Aetna, have a history of nickel-and-diming customers in chronic pain. It’s why the American Academy of Orthopaedic Surgeons issued a position statement calling out insurers’ tendency to incorrectly label medically-accepted procedures as “experimental.” 

Not many of you will have heard of the condition of FAI. But we all together have to make sure insurance companies can’t get away with decisions that put the desire to save money ahead of the medical necessity of paying members.

Please join me in demanding Aetna follow the practice of other major insurers and end its unethical denial of coverage for FAI patients. Aetna is not only denying us coverage, it is denying us a pain-free life.

With my doctor’s support, I am on my second appeal to the company, and know your help -- especially if you are an Aetna customer -- will support my case and the case of other customers who are needlessly suffering in pain.

Recent signatures

    News

    1. Even better news!

      Jess Leber
      Petition Organizer

      Aetna has changed its policy to cover FAI as "medically necessary."

    2. Reached 1,000 signatures
    3. Great news!

      Jess Leber
      Petition Organizer

      Due to her dogged efforts and activism, Ryan got a call from Aetna that her surgery will be covered. But she still wants Aetna to change its policy so all people suffering from FAI can benefit from the same surgery. Keep signing her petition!

    4. Why I'm Asking Aetna to Cover My Surgery

      Jess Leber
      Petition Organizer

      Below is a guest post from Ryan Carroll, from Bealeton, Virginia, about why she created a petition to ask Aetna to pay for her surgery. You can see her petition here.
      As a young teenager, I was a gymnast and a competitive cheerleader. My nickname...

    5. Reached 750 signatures
    6. Aetna's policy is in DIRECT CONTRAST with the AMA!

      Ryan Carroll
      Petition Organizer

      In Aetna's policy for FAI Surgery for Hip Impingement Syndrome (#0736), they state that Aetna "considers femoro-acetabular surgery, open or arthroscopic, for the treatment of hip impingement syndrome experimental and investigational because its clinical value has not been established."
      Their reasoning for denying coverage is a complete contradiction to the American Medical Association. One of the duties of the American Medical Association (AMA) is to issue "CPT" codes. For a CPT code to be issued, it has to meet specific criteria including (according to the AMA website) "that the clinical efficacy of the service/procedure is well established and documented in U.S. peer review literature." So, while the AMA considers FAI surgery to be a "well established and documented procedure" , Aetna is deeming it "experimental". It seems to me that Aetna is working to protect only one interest here ... their own.

    7. Reached 250 signatures

    Supporters

    Reasons for signing

    • Charisse Savier ALLIANCE, OH
      • over 2 years ago

      Pain is now considered the 5th vital sign because uncontrolled pain adversely affects numerous other body systems, leads to a poor quality of life & contributes to chronic anxiety/depression. It interferes with relationships & being able to enjoy life, leading to seclusion & isolation.

      REPORT THIS COMMENT:
    • Mari Anne Roberts MCDONOUGH, GA
      • over 2 years ago

      Living in cronic pain is horrible affecting every minute of every day. Insurance companies should be held accountable.

      REPORT THIS COMMENT:
    • STEPHEN SZPILA ROCKFORD, IL
      • over 2 years ago

      If Medicare covers it all major insurers should have no issues or excuses for denying coverage. You have a Orthopedic Surgeon calling for it as "medically necessary" and who are they to deny you. They are just upset that they are the ones who insure you. My sister had issues with Aetna due to her Non-Hodgkins Lymphomia. Aetna is PIA with there excuses. Come-on Aetna do what is right to cover your client correctly and ethically. Ask for a new patient Case Worker.

      REPORT THIS COMMENT:
    • Anthony LaMesa OLD LYME, CT
      • over 2 years ago

      Aetna engages in chronic unethical behavior.

      REPORT THIS COMMENT:
    • Karoline Archey NORTH HOLLYWOOD, CA
      • over 2 years ago

      My husband is sufering from terrible hip pain as well as groin pain. He is hoping for releif ans surgery soon. Only doctors should be able to make these calls NOT the isurance companies who car only about their bottom line and not the health and well fair of patients. This is where reform is needed.

      REPORT THIS COMMENT:

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