As many of you can attest to firsthand, Aetna is still not covering FAI surgery and still calling it "experimental", despite hundreds of peer reviewed articles that say otherwise. Although I do not use Aetna, I feel for all of you who do, and are not able to have your surgery paid for. Below is a link to a petition started by fellow FAI sufferer Ryan. Please take a few moments to look over the information and sign the petition if you agree.
3 comments:
I've been fighting Aetna to get my FAI covered since March 2011. So frustrating. I'm tired of living in chronic pain and having to adapt my lifestyle and the things I want to do because of my hip. I'm too young for this, and I'm exhausted living like this. Thanks for posting this.
I just received an email from Aetna re: my petition signature. This is what they said:
We recently conducted an exhaustive review of our Clinical Policy Bulletin (CPB) for FAI surgery, as documented on our public web site in CPB 0736 at http://www.aetna.com/cpb/medical/data/700_799/0736.html. We concluded that FAI surgery is experimental and investigational because it has not been proven that surgical treatment is more effective than treatment without surgery, or whether one type of FAI surgery is more effective than another. Aetna posts its CPBs on its public web site so that members and doctors know what we cover and why, including a listing of the clinical studies and medical research reviewed.
In brief, the body of medical research for FAI is limited primarily to a series of cases rather than a controlled clinical study that compares patients who have the surgery to a group of patients who do not have the treatment. A comparative group of patients, which is called a "control group" in clinical studies, is especially important when researching treatment for pain relief. In addition to a lack of reliable medical evidence on the effectiveness of the procedure, there is little research to show if the procedure holds up over the long term, or whether it prevents the development of arthritis or delays the need for hip replacement.
Aetna’s conclusions on FAI are supported by an independent, systematic clinical evidence review commissioned by the Washington State Health Care Authority and published in August 2011. Among its conclusions, the assessment found "no data to assess the short- or long-term efficacy of FAI surgery compared with no surgery," and "there are no data yet published to test the hypothesis that FAI surgery prevents or delays hip osteoarthritis or the need for total hip arthroplasty."
We will continue to monitor the emerging medical literature on FAI surgery. While we understand this is not the response you wanted, we hope that you appreciate the extensive reviews we conduct to ensure that procedures have been proven safe and effective for Aetna’s members. Thank you for reaching out to us.
Melissa Alexander
Head of Complaints, Grievances and Appeals
This may be too late, but you should know that the science in Aetna's clinical policies is very poor. You should check out www.healthinsfrustrations.com where there is a similar exhaustive point by point attack on Aetna's Physical Therapy policy.
But there is another option. With the PPACA, you can file an EXTERNAL appeal that will go outside Aetna to a physician in that field. The above website has tips on doing that and if you need help, ask.
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