Aetna and FAI 2

A few months ago a fellow hipster sent me a post and asked me to publish it on my blog. It was about Aetna and their refusal to cover FAI surgery. That post generated many replies, including the one below.
This is a response from Aetna:

The date on our website is not the date that the update will be published, but the date that it will be discussed by our Clinical Policy Council. All updates have to go through a subsequent review, approval and implementation process. We expect the update to be published by the end of the year.



Should you have any questions or concerns, regarding these policies contact provider of services dedicated lines; Indemnity and PPO- based benefits plans 1-888-MD Aetna (632-3862) for HMO benefits plans – 1800-624-0756. Our Provider Service Representatives are trained to specifically handle any concerns you may have.



Also, for your convenience any future concerns or questions regarding our policies can also be faxed to us at 859-425-3379.

November 18, 2010 11:56 PM

Below is the original post:
Sent to me by a fellow hip friend:

Aetna’s assessment of FAI is archaic and asinine!

As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.


Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?



Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.



Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?posted by Susie at 7:47 PM on Sep 28, 2010

Double Update

Hip: I had an appt with my hip OS a few weeks ago but haven't had a chance to post yet. I am almost 1 year out from my last (4th) hip scope and very pleased with the results. I have no pain at all in my hip. the only residual effect from that surgery is that my hip is really tight and still catches and pops quite often. I don't care though, I will take that over groin pain any day. My OS explained that during the capsule tightening procedures, sometimes they make it a little too tight, he recommended more PT to keep it loose, since that is what I do when it gets bad, but he would like me to take a more preventative approach with PT and go before it gets bad. In theory, that is a wonderful idea, in reality, who has time for more PT!!! He also offered me a cortisone injection into the capsule, which I politely declined as well...no more hip injections for me! I will deal with this!

Shoulder: It has been 2 weeks since I had the AC joint injected and I am thrilled with the results. The joint does not hurt at all anymore. Although I still get some pain around the area sometimes, It is tolerable. In a very "susie-like" fashion, I requested the OS office note and the radiology report on my x-ray...OS suspects AC joint arthritis, if the injection doesn't help he will order an MRI to rule out osteolysis, which is not a common problem in 30 year old housewives!!!! (ok, I work too, but still...), it is more of a weight lifter issue, and the only weights I lift are 40 lbs toddlers and pots and pans!!!!

Cost of Hip Arthroscopy has been updated

http://susie711.blogspot.com/2008/01/cost-of-hip-arthroscopy-and-its.html


Surgery # 4 numbers have been added...1 year later!! Life has been pretty busy!