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.
Cover the surgery needed to repair Femoro-acetabular Impingement.
Femoro-acetabular Impingement (FAI) is a painful and debilitating hip condition that typically effects young active people and athletes. It is a degenerative disease caused by too much friction in the hip joint. In short, the bones of the ball (femoral head) and socket rub abnormally creating damage to the hip joint to include tears in the surrounding cartilage. If left untreated, this can lead to osteoarthritis, and ultimately the need for a total hip replacement. The longer this pathology continues, the more damage is done.
FAI surgery has been around for approximately 10 - 15 years, and has been proven to be an extremely effective treatment for this form of hip disease. In the past, the patient would have to wait until the degeneration had progressed to the point where a hip replacement was the only option to correct the problem. However, hip replacements are much more invasive to the patient, often need to be redone, and are much more costly to the insurance company. Therefore, FAI surgery is the best choice. FAI surgery is a one time occurrence. Once the malformed bones are fixed, the patient can return to his/her active happy pain free life. Almost ALL major medical insurance companies (including Medicare, BCBS, United Healthcare, Cigna, and more) cover this policy and consider it "medically necessary". In addition, the American Medical Association has granted CPT codes which can only occur when the following criteria are met (as stated on the AMA website):
*That the service/procedure has received approval from the Food and Drug Administration (FDA) for the specific use of devices or drugs;
*That the suggested procedure/service is a distinct service performed by many physicians/practitioners across the United States;
*That the clinical efficacy of the service/procedure is well established and documented in U.S. peer review literature.
Aetna, however, considers the surgery to be "experimental and investigational because its clinical value has not been established." This reasoning is out of date, unfounded, unfair, and unethical. It is also in direct contradiction to the American Medical Association's findings. As a result, patients with FAI, are suffering and living with pain that increases on a daily basis. Please for Ryan Carroll, her family, and other patients suffering from FAI, push Aetna to cover the CPT codes: 29914, 29915, 29916, 29862, and 29863. Because living pain free should be a right for every human being.