Aetna’s cataract surgery pre-authorization rule creates “chaos” for backlogged providers


Aetna now requires all patients to receive pre-approval for cataract surgery.

The Hartford, Conn.-based insurer said it had spent the past few months reaching out to opthamologists in its networks to inform them of the policy change, which took effect July 1.

“We also reached out to the American Ophthalmological Society and American Society of Cataract and Refractive Surgery to explain the rationale for and discuss this new policy, ensuring them that we’d work collaboratively to make sure that their patients and our members would have timely access to appropriate, necessary care, with special attention during the first few weeks of this new policy,” a spokesperson said in a statement.

But the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery dispute Aetna’s timeline, saying that the insurer did not notify providers before making the change, forcing some ophthalmologists to postpone procedures until they receive approvals.

Aetna told the medical societies that physicians should cancel planned cataract surgeries during he first half of this month, delaying surgeries for up to 20,000 patients, the industry organizations say.

The insurer promised to approve 95% of surgery requests but offered mixed messages on how quickly these approvals would come in, according to the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery. Some clinicians were told approvals would be “instant” while others heard they could take up to 14 days, the groups say.

Aetna’s policy change comes as opthamologists are struggling with a flood of new patients requesting surgeries after they delayed care during the COVID-19 pandemic, the medical societies say. They urged Aetna to reverse its policy, which is “causing chaos at the doctor’s office,” they say.

“There’s almost no other surgery as effective and transformative as cataract surgery,” the groups said in a release. “It allows people to recover their lives. We have asked Aetna to immediately withdraw the program. They have declined to even pause it until physicians and patients can be educated on it.”


Source: modernhealthcare.com

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