Aetna to Halt Prior Authorization Requirement for Cataract Surgeries

Aetna, a managed care company, announced on June 30 that patients would no longer need pre-approval for most cataract surgeries starting on July 1. The announcement covers all patients except for those enrolled in Medicare Advantage in Florida and Georgia.

The announcement comes 1 year after Aetna instituted a new policy that required pre-approval for all physician-prescribed cataract surgeries. The policy, which affected children born with cataracts to patients requiring emergency cataract surgery, had received criticism from the ophthalmology community.

The American Academy of Ophthalmology (AAO) estimates that Aetna’s policy requiring pre-approval for cataract surgery affected between 10,000 and 20,000 Aetna beneficiaries who had their cataract surgery delayed in the July of 2021 alone.

“Aetna’s decision to impose a prior authorization (PA) requirement for cataract surgery was very difficult to understand since the indications for surgery are well established and the benefits clear,” said Stephen D. McLeod, MD, CEO of the AAO, in a statement. “And the immediate impact on patients subject to unnecessary delay should have been obvious.”

The AAO, along with the American Society of Cataract and Refractive Surgery, provided data on patient cases that supported a rollback of the policy. Advocacy for the rollback included meetings with CMS and working with bipartisan Congressional leaders.

The meetings with Congressional leaders led to the advancement of the Improving Seniors’ Timely Access to Care Act of 2021, which has received support from 300 US House members and 34 senators. The Act would streamline and standardize the PA process for patients with Medicare Advantage coverage, which would provide oversight, transparency, and protection from unnecessary delays and denials.

The legislation would require the Medicare Advantage program to establish an electronic PA program, annually publish specified PA information, ensure PA requests are reviewed by qualified personnel, and protect beneficiaries from disruptions in care due to prior requirements.

“We thank the original sponsors of the bills…for their steadfast leadership in advancing legislation that will help to ensure our nation’s seniors continue to receive the high-quality, timely care they deserve,” said David Glasser, MD, the AAO's secretary for federal affairs, in the statement.

The AAO said their leadership will remain vigilant in protecting patients and physicians from abusive health insurance practices.

Reference

Big win for patients: Aetna drops prior authorization for most cataract surgeries. American Academy of Ophthalmology. June 30, 2022. Accessed July 1, 2022. https://www.aao.org/newsroom/news-releases/detail/big-win-patients-aetna-drops-prior-authorization