In the fall of 2017, AANA members reported increasing number of denials, by commercial insurance carries, related to use of Hyaluronic Acid (HA) injections for treatment of osteoarthritis of the knee. Many of these negative coverage determinations referenced the 2014 AAOS Clinical Practice Guidelines on treatment of Osteoarthritis of the Knee (non-arthroplasty), which came out with a recommendation against the use of HA. In responses to member concerns, we issued a survey to gain a better understanding of how these reimbursement decisions impact AANA members and their patients. The survey respondents overwhelmingly supported use of HA, for management in select patients with symptomatic osteoarthritis of the knee. Following the survey, AANA leadership discussed this issue with the AAOS leadership and detailed the concerns of our members. AANA leadership drafted a letter, outlining the scientific and clinical evidence supporting HA, and made it available to members for use in discussions with payers. Several state level discussions ensued, and to date, commercial insurers in Minnesota, North Carolina, South Carolina and Florida have reversed decisions in support of coverage for HA in select patient populations.