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Dear Mr. Potter,

I am a member of a very large patient support group that provides support to patients worldwide. The diagnosis that each patient has in common is Femoroacetabular Impingement (FAI). Basically, in layman’s terms, there are large bone spurs in the hip that contribute to torn cartilage. The medical profession, fortunately, is able to fix this with minimally invasive surgery (arthroscopy) such as what A-Rod just recently had. That is the good news!

The unfortunate part is that there are two main insurers that are discriminatory in their coverage. Blue Cross/Blue Shield, Cigna and Kaiser all pay for this surgery. Aetna and United Healthcare do not. In fact, United Healthcare just wrote a policy that would deny all coverage for ANY surgery that would fix this (open or arthroscopic). Both United Healthcare and Aetna both have adopted the opinion that this surgery is “experimental” in direct contrast to their peers (BCBS, Cigna, Kaiser) who have recently adopted coverage policies based on scientific evidence and peer reviewed studies. United Healthcare and Aetna would prefer that young active patients become disabled enough to require a more expensive and potentially riskier hip replacement.

As you also may be aware there have been multiple million dollar fines against United Healthcare specifically as well as a pretty recent class action lawsuit against UHC brought by Cuomo of New York.

My experience with UHC is that the external reviewer that reviewed my claim for coverage indicated that UHC was being arbitrary and unethical in their decisions and UHC was ordered to pay it. It was shortly after this that UHC came up with a formal policy that indicated that the surgery was unproven.

Our group is reaching out to your organization to be able to get UHC and Aetna to see the peer reviewed literature that does support this procedure and to also make contact with the media.