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I-Team's Call For Action Helps Canton Man Get Aetna To Cover $15,000 Spinal Surgery

CANTON (CBS) - Mountain biking was David Folan's way to cope with the stress of the pandemic.

"It's cathartic because when you are on a mountain bike, the only thing you think about is being on a mountain bike. You don't have the ability in your brain to think about anything else, otherwise, you fall down," he said.

But last spring, he was sidelined with a lumbar spine compression.

"It was a constant sharp pain down my leg, it really gets quite unbearable," he said.

His doctor recommended a spinal surgery that would relieve the pressure.

"He said, 'David, when you wake up, your pain is going to be gone, period,'" Folan recalled.

But his November surgery was canceled when his insurance company, Aetna, refused to cover it.

"I have a stack of paperwork talking about all of the denials starting in October," he said while showing us a call log from the surgeon's office. It noted more than a dozen calls to Aetna trying to get the surgery approved.

His surgery was rescheduled for Monday, December 20.  According to David, Aetna again denied covering the surgery just days before.

"Then, I just decided just to give the hospital a credit card and to pay for it myself," David said, recalling his desperation. "I wasn't going to cancel this one because I was in too much pain."

We met David at his home in Canton two days later. He was moving slowly but was up and around.

"It was immediate. As soon as I woke up from the anesthesia, my pain was gone."

But he was on the hook for $15,000, and that was before any of the doctor's fees. He asked the I-Team for help, and we contacted Aetna.

"It wasn't until they got a phone call from you, WBZ, that all of a sudden, low and behold, look what happened. It got approved," he said.

In an emailed statement to the I-Team Aetna said:

All of our members have the opportunity to appeal coverage decisions. On December 14, 2021, we received an appeal with additional clinical information and approved coverage of Mr. Folan's procedure. He and his provider have been informed of the approval.

Folan says he is now pain-free and looking forward to getting back on his bike.

"It feels unbelievable. I appreciate the phone calls you guys made to talk to Aetna."

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