Aetna rolls back policy requiring pre-approval for cataract surgery
Needed surgeries were delayed due to the former policy, says American Academy of Ophthalmology.
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Aetna is no longer requiring precertification for cataract surgery.
Aetna is rolling back on policy it announced last year and is no longer requiring pre-approval for cataract surgeries, except for people enrolled in Medicare Advantage plans in Florida and Georgia.
Cataract surgery for Florida and Georgia MA beneficiaries will still require prior authorization through iCare, according to the American Academy of Ophthalmology.
The Academy called Aetna's decision a big win for patients and said it strongly advocated for the change in the policy requiring pre-approval for all physician-prescribed cataract surgeries.
The policy applied equally among its members, from children born with cataracts, to adults whose cataracts interfere with their ability to drive, to people in need of emergency cataract surgery before vision-threatening retinal conditions can be treated, according to the Academy.
WHY THIS MATTERS
The Academy estimated that in one month alone cataract surgery was delayed unnecessarily for 10,000 to 20,000 Aetna beneficiaries.
"Aetna's decision to impose a prior authorization requirement for cataract surgery was very difficult to understand since the indications for surgery are well established and the benefits clear," said Dr. Stephen D. McLeod, CEO of the Academy.
THE LARGER TREND
Academy advocacy efforts included working with bipartisan congressional leaders to advance the Improving Seniors' Timely Access to Care Act of 2021.
If enacted, the legislation would streamline and standardize prior authorization in the Medicare Advantage program by establishing an electronic prior authorization program that would require MA plans to adopt these capabilities and provide real-time decisions.
Twitter: @SusanJMorse
Email the writer: SMorse@HIMSS.org
