Health

Aetna adopts a pre-authorization rule for cataract surgery

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

The Hartford, Conn. Insurer said it had spent the past few months searching for ophthalmologists on its networks to inform them of the policy change, which went into effect July 1.

“We also reached out to the American Ophthalmological Society and the American Society of Cataract and Refractive Surgery to explain the foundation of discussions of this new policy, assuring them that we should work collaboratively to ensure that their patients and our members have access to it. timely access to approve the necessary care, with particular attention during the first weeks of this new policy, ”a spokesman said in a statement.

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

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Aetna has told medical companies that doctors will cancel scheduled cataract operations during the first half of this month, delaying operations by up to 20,000 patients, industry organizations say.

The insurer promised to approve 95% of surgery requests but offered mixed messages about the speed of those approvals, according to the American Academy of Ophthalmology and the American Society of Cataracts and Refractive Surgery. Some clinicians have said the approvals will be “instantaneous” while others have heard they can take up to 14 days, the groups say.

Aetna’s policy change comes as ophthalmologists are struggling with a plethora of new patients requiring surgery after they delayed care during the COVID-19 pandemic, medical companies say. They urged Aetna to reverse her policy, which “causes chaos in the doctor’s office,” they say.

“There is almost no other surgery as effective and transformative as cataract surgery,” the groups said in a statement. “It allows people to get their lives back on track. We have asked Aetna to withdraw the program immediately. They have also refused to pause until doctors and patients can be educated on this.”


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