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Petitioning Vice President, Investor Relations, Health Net, Inc. Angie McCabe and 12 others

Tell The DoD & TRICARE to stop failing military beneficiaries in pain!

** UPDATE  (01/23/2013) **

Thank you all again for your continued support- I'm still fighting but basically MUST give in now & pay for surgery myself...

I can NO longer go without surgery. I am in pain EVERYDAY & there are so many, many things that I cannot do & it is driving me crazy. My husband is deploying soon to Afghanistan & I absolutely cannot get along caring for my daughter & our home in this condition without him. 

So long story short I am going in for surgery February 1st. I have tried EVERYTHING all to no avail. I have played by the "rules". I have filed appeals, I have done everything TRICARE has requested of me & I am still being denied.  

I am asking now if you feel inclined for donations to my surgery fund. Surgery will cost us $10,000. $10,000 we do not have & must raise. Please visit my donation site here: http://www.gofundme.com/1wp4qw & share with anyone else you think could help. 

THANK YOU!

 

** UPDATE (10/10/2012) **

I received my third & FINAL denial letter from TRICARE on October 6th, 2012. TRICARE will NOT be allowing me to have arthroscopic surgery to repair my torn labrum & address FAI issues. TRICARE still believes the surgery to be "unproven/experimental" and therefore not a "covered benefit". My only option now is for my husband & I to find a way to come up with roughly $10,000 to pay for the surgery ourselves. Your help in signing & sharing this petition has never been more important! Please help! **

I have lived with hip pain for approximately 10 years. I was always told I was just growing or it was "normal". While pregnant with our first child I experienced worsening hip pain, at times I even felt like my entire pelvis was going to give way. Again I was told this was "normal" and my pain was from my hips "widening" in preparation for birth.

Flash forward a year... still feeling extreme discomfort, clicking, locking and general weakeness in my pelvis (especially in my left hip) happening daily & pretty much with every movement or step, it was suggested to me by my OBGYN that I see an orthopaedic. That maybe, my hip pain was not to be classified as "normal" or associated with the general "prepartations" the body makes in order to give birth.

In March of 2012 after x-rays & a visit with the doctor an MRI Arthrogram was ordered. After that test it was determined by my doctor that I had a torn labrum (cartilage in the hip) and surgery would be my best option. This admittedly freaked me out a bit & I scheduled a second opinion with an alternate doctor at a completely different practice. The second doctor determined the same and also recommended surgery as my best option. 

I met with my first doctor again in the begining of May 2012 and surgery was scheduled for July 18th, 2012. Preparations were made with my family to ensure I'd have a place to recover that did not require me to do stairs & also to ensure that my 16 month old daughter would be taken care of as well as I am a stay at home mom. I also greatly modified my work schedule as a photographer and did not schedule any clients.

On June 28th, 2012 the day after all my pre-op testing was done in preparation for the surgery I received a call from my doctor's surgical coordinator. Apparently my surgery was being denied by TRICARE. Neither of us taking the denial too seriously, as it was probably just a little mistake in coding or something, I was told by the surgical coordinator that they would re-submit the request with more documentation and check the codes. Little did we know, as we were not informed, this resubmission started the appeals process for which I've been told repeately by over ten TRICARE representatives can take "60 days". I do not have 60 days. I should not have to push out this much needed surgery for which many arrangements (child care, time off from work, etc) have been made. I am in constant pain, every single day. And as time passes I am only becoming more and more debilitated. My condition is a degenerative one and will only get worse. For TRICARE, ultimately under the guidance of The Department of Defense, to deem my surgery as "unproven and experimental" and therefore "not medically necessary" is illogical and unfair. 

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.

As stated above, TRICARE, under the guidance of The Department of Defense, however, considers the surgery to be "unproven & experimental" 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 me, Ashley Lynn Fry, my family, and other patients suffering from FAI, push The Department of Defense and TRICARE to cover the CPT codes: 29914, 29915, 29916, 29862, and 29863 in regards to FAI. Because living pain free should be a right for every human being.

I'll say it again, The Department of Defense and TRICARE should recognize and 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, 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 and our government 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 The Department of Defense & TRICARE follow the practice of other major insurers and end its unethical denial of coverage for FAI patients. Both The D.O.D. and TRICARE are not only denying us coverage, they are denying us a pain-free life.

 

This petition was delivered to:
  • Pennsylvania State House
  • U.S. Senate
  • U.S. House of Representatives
  • Attorney/Advisor Appeals, Hearings and Claims Collection Division Office of General Counsel
    Fred L. Mascarena, Jr.
  • Assistant Secretary of Defense for Health Affairs
    Dr. Jonathan Woodson
  • United States Department of Defense Military Health System
  • Director of Communications Health Net Federal Services
    Molly Tuttle
  • Assistant Vice President Training & Development Quality Assurance
    Myriam G. Alonso, PH. D.
  • Vice President, TRICARE North Region
    Jeff Littlefield
  • Pennsylvania Governor


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