Convince Aetna to Provide Positive Coverage for Lumbar Artificial Disc Replacement Surgery
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Aetna is the United States' third largest health care insurance company with 22+ million members, yet it does not provide positive coverage for lumbar artificial disc replacement surgery.
Lumbar artificial disc replacement treats severe chronic lower back pain caused by degenerative disc disease, herniation, and/or stenosis by replacing a damaged disc with an artificial disc.
The replacement disc preserves the motion and dynamics of a human lumbar disc, restoring flexibility, preventing further degeneration of adjacent segments, and eliminating patients back pain while allowing them to enjoy everyday activities.
The irony is that Aetna used to provide coverage for disc replacement. Aetna was actually the first company to cover and claimed disc replacement was medically necessary for spinal arthroplasty for patients with degenerative disc disease at one level from L4 to S1 who have failed at least six months of conservative management.
In mid-September 2013, Aetna ceased coverage for lumbar disc replacement. Why? You can learn more about the history and events that led up to their change in policy here.
Regardless of the past, we are here to make a difference for the present and future.
The goal of this campaign is to unite and prove to Aetna that it is time to reverse its policy of non-coverage for lumbar artificial disc replacement.
In June, Aetna’s clinical policy will be up for review. Insurance companies use annual policy reviews to determine whether procedures, services or supplies are "medically necessary, experimental and investigational, or cosmetic" in determining which position they will take.
When asked about its clinical review protocol for lumbar disc replacement, a representative at Aetna stated, “As with all of our policies, we will go through an annual review about mid-year. As part of that review, we will perform a thorough clinical evidence review and evaluate any information that we receive on the topic.” Should Aetna's upcoming review yield the same outcome as its previous decisions, policy holders can expect a continuation of negative coverage for lumbar artificial disc replacement procedures.
BackerNation (digital health and wellness for back pain and spine) founder and CEO, Jay Resio, had artificial disc replacement surgery. He suffered from degenerative disc disease for years. Jay herniated his L4-5 disc four times, which led to four surgeries... three discectomies and finally a lumbar disc replacement.
From Jay Resio:
"For over 5 years, I lived in constant pain from my discs either being herniated and putting pressure on my nerves or my degenerative discs causing inflammation in my muscles and joints.. my back, hips, butt, legs, knees, ankles.. the pain radiated everywhere. Even after I had each discectomy, my back never truly felt right. While it was an initial relief from the sharp nerve pain, my back always felt 'sick' in one form or another.
Getting disc replacement changed my life. I could not imagine what life would be like right now if I didn't have disc replacement surgery. I would still be in constant pain trying to figure out how to function each day. It was no way to live as each day became more painful.
These days... I feel amazing... staying active and productive with work, family and friends. Before I couldn't keep up with anyone except maybe my couch or bed (and even just laying there was painful). Today, no one can keep up with me."
Join BackerNation and its community of back pain warriors in helping to convince Aetna to change its coverage policy for lumbar disc replacement surgery.
80% of the population will suffer from some type of back issue in their lifetime.
We want to hear from everyone...
- Back pain patients
- Aetna patients that have been denied coverage
- Family members of back pain warriors
- Doctors and surgeons
- Chiropractors, physical therapists, massage therapists, and other back and spine service providers
- Health care executives and professionals
Please sign this petition and share your stories, feedback and insights.
"Never underestimate the influence you have on others."
- Laurie Buchanan, PhD
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