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.