Why I'm Asking Aetna to Cover My Surgery

Below is a guest post from Ryan Carroll, from Bealeton, Virginia, about why she created a petition to ask Aetna to pay for her surgery. You can see her petition here.

As a young teenager, I was a gymnast and a competitive cheerleader. My nickname was “The Toe-Touch Queen” because I could bust out roughly 15 perfectly executed toe-touch jumps. If only I had a crystal ball to look into the future…

Around the age of 17, I began to develop mild hip pain. Specialists told me I had mild arthritis and gave me prescriptions for medication and physical therapy.

Although these treatments helped, they didn’t help for long. As the years passed, I learned to deal with the hip pain. Hot baths, ice, Motrin… these became part of my daily routine. I accepted it as part of my life, and moved on.

In 2001, I married my best friend. He was (and still is) an officer in the U.S. Army. He has been deployed twice since we were married, and he is proud to protect and serve. We had always wanted a big family, so we started right away. Through international adoption and natural conception, we’ve been blessed with four beautiful children. My kids are my life. I live and breathe for them, and ultimately wish I could be the active and healthy mother that they deserve.

In 2010, with my husband on a 12-month deployment in the Middle East, I had my hands full with my four energetic kids. Although my hip pain had always been there, nagging at me, it really began to intensify. 



I met with an orthopaedic surgeon who diagnosed me with two hip conditions. The first one was “Iliotibial band syndrome”, and the second was “Femoro-acetabular Impingement” (FAI)— the cure was two surgeries. My first surgery in July of 2010 was successful, but my groin pain continued due to the FAI—a condition where the bones of the hip joint abnormally rub together creating damage to the surrounding cartilage.

Around that time, my husband moved to a new company, and our insurance provider changed to Aetna. I found a new orthopedic surgeon who accepted Aetna, and he too gave me the same diagnosis. FAI is a degenerative disease, and pain increases with time. Another hip surgery might seem like bad news to most people, but I was eager. After years of increasing pain, I was thrilled at the prospect that there was an end in sight.

Unfortunately, this was when my nightmare really began. 

As is typical, my surgeon sent a request to Aetna for pre-approval of the surgery. Aetna denied the claim. According to its Policy #0736, FAI surgery is “experimental and investigational.”

Although I was upset with Aetna’s decision, I wasn’t ready to quit fighting.

My research shows that other health insurers, including Blue Cross Blue Shield, Medicare, Cigna, and United HealthCare, all cover the surgery and state that it is established and medically necessary. My research also shows that there is overwhelming evidence supporting FAI surgery. The American Medical Association believes that it is well established procedure, and even the American Association of Orthopaedic Surgeons issued a position statement saying “unequivocally that if a service or procedure has a Category I CPT code, it is not experimental or investigational.”

At present time, I am preparing my second appeal.

I have also started a petition on Change.org because I know others who suffer from FAI are fighting the same battle as I am. Already, as of today, more than 700 people have signed and left many notes about their experiences.

The evidence supporting this surgery is overwhelming; however it seems as if Aetna continues to ignore the proof in order to protect their own monetary interests. In the meantime, patients like me are suffering on a daily basis.

At a broader scale, insurers should not deny reimbursement for these services by claiming they are experimental. When they do, they threaten the health of the public and unjustifiably interfere with the physician/patient relationship.”

Aetna’s decision to deny their members this proven and effective surgery is unfair and unethical. I hope that by starting this petition, Aetna will see the need for a change in their policy.

After all, I’m not asking for the world. I just want to enjoy playing with my kids.