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
9 comments:
Aetna just published their "updated" policy today and they still consider FAI surgery unproven and will not cover it. Very disappointing.
http://www.aetna.com/cpb/medical/data/700_799/0736.html
Shocking and disgusting!
Aetna is for sure archaic. How can they say its experimental when all the other major insurers cover?
Ridiculous!
My surgery has been rescheduled twice now because of aetna. Initially my predetermination letter was submitted to aetna. It was reviewed by a "HEMATOLOGIST" Who made the decision to deny this procedure. My Dr. is now appealing with a more detailed letter. One would think it would have been a Orthopedic that reviewed these records and based his decision on an educated opinion.
I would like to include two things in my Aetna appeal, #2. What is the link to the New York Times article? And my state department of insurance says I need to provide proof Aetna has overturned an appeal for other patients to help my case. If someone has successfully fought Aetna and is willing to provide their first name and case number, that would help us all.
Fighting to stay active and healthy is crazy!
Well my first appeal from aetna has been denied. They have stated that they will uphold their decision that the procedure is experimental and investigational. I will continue to limp on. I am a hairstylist, how do I continue to work with this pain.
there are several blue cross plans in my state.
some of them cover FAI surgery. some do not. I have the bc/bs that does not!! just found out today. I'm devastated -- but will go for the appeal. thank you for all of the resources you have on your blog.
My FAI surgery was recently denied by Aetna. I am appealing but sounds like it will not help. If anyone has any luck, please keep us posted. I live in Illinois and have filed a grievance with the state board of insurance. http://insurance.illinois.gov/
Supposedly they will review. I am furious. They won't cover it yet offer no alternative approach.
Aetna just published their new FAI policy statement 7/29. It is not up for review until 9/2012! There is a Facebook page "Class Action Lawsuit against Aetna." Perhaps we should be talking about that.
Has anyone been successful at getting Aetna to overturn the denial?
I'm working on appeal #2 and discouraged by this new policy.
Aetna changed there policy regarding FAI. They are now covering the surgery. see http://www.aetna.com/cpb/medical/data/700_799/0736.html
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