Ophthalmology groups urge reversal of Aetna’s cataract surgery prior authorization policy
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A new Aetna policy that requires prior authorization for all cataract surgery procedures could result in safety issues and a worse quality of life for patients, according to two ophthalmology organizations.
The American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology said the policy, which went into effect July 1, has already resulted in surgery cancellations for this month, as well as confusion in the ophthalmology community.
“Once a patient has made a decision to proceed with surgery, they usually want it done as soon as possible,” Richard S. Hoffman, MD, ASCRS president, told Healio/OSN. “Having prior authorization added to the mix increases the possibility of further delays, inefficiencies and, at worst, downright denials to have surgery. ... Adding delays to sight-restoring surgery is irresponsible and potentially dangerous to patients.”
ASCRS said it met with Aetna along with AAO representatives to discuss the policy in June. Despite voicing their concerns about transparency and other issues, the organizations said the insurance company was not able to give them adequate justification for the policy change.
ASCRS, AAO and the American Society of Ophthalmic Administrators are calling on Aetna to rescind the policy, and ASCRS has asked members to contact the insurance company.
One concern brought up by both organizations is that the policy will compound delays caused by the COVID-19 pandemic, resulting in a larger backlog of patients waiting for surgery.
“Adding another layer of administrative oversight and approval will only slow down the system,” Hoffman said. “This may ultimately be the goal of Aetna. There have not been any studies to my knowledge that demonstrate that there is abuse of cataract surgeries requiring the need for prior authorizations. It is an incredibly successful surgery with life-changing results for most patients. So, why institute this policy?”
In calls with Aetna, physicians have reportedly been told that authorization could take anywhere from 1 to 14 days, according to an AAO press release. The organization estimated that between 10,000 and 20,000 patients could have their surgeries delayed in the first month after the policy’s implementation.
Hoffman said there is no way to be sure just how long this policy might delay surgeries, but his main concern is that it puts the surgery decision in the hands of an insurance company.
“Some cases look borderline on paper for review. However, the patient may be having significant issues with their night driving or performing activities that require keen eyesight,” he said. “The average patient probably would not be bothered by this limitation in vision, but other patients who require a high level of acuity would be impaired. The best two people to determine whether the surgery is appropriate are the patient and the surgeon. Having an employee of an insurance company who may not even have medical background determine the appropriateness for surgery is a formula for frustration and delay.”
Reference:
ASCRS press release regarding prior authorization policy. https://ascrs.org/news/ascrs-news/ascrs-press-release-regarding-prior-authorization-policy. Published July 1, 2021. Accessed July 6, 2021.
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