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Cataract Surgery
Medicare/Payer/Legislation

Aetna Drops Prior Authorization Requirement for Cataract Surgery

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After Yearlong Fight, Aetna Drops Policy Requiring Prior Authorization for Cataract Surgery in All but Two States

For the past year, ASCRS has been advocating on behalf of its members and cataract surgery patients to remove a harmful policy put in place by Aetna that required preauthorization for cataract surgery. ASCRS is pleased to announce that as a direct result of its advocacy, with collaboration from the American Academy of Ophthalmology (AAO) and the grassroots efforts of our members, Aetna is dropping this policy.

Aetna will no longer require prior authorization for cataract surgery, except for Medicare Advantage (MA) beneficiaries in Florida and Georgia as of July 1, 2022.

“As president of ASCRS, I’m thrilled about the work that was done over the past year by ASCRS and AAO that led to Aetna dropping its prior authorization policy for cataract surgery. As Richard Hoffman, MD, said last year, ‘the best two people qualified to determine if cataract surgery is necessary are the patient and their ophthalmologist.’ I could not agree more and am pleased that right has been restored,” ASCRS President Douglas Rhee, MD, said. “I’d like to personally thank the members of the ASCRS Government Relations Committee, ASCRS Government Relations staff, and the members who personally reached out to Aetna for their tireless efforts advocating to maintain access to vision-restoring care for our patients.”

Aetna’s decision to require prior authorization of all cataract surgery procedures went into effect on July 1, 2021. This policy created overly burdensome amounts of work for ophthalmic practices, resulting in tens of thousands of delayed cataract surgeries and even denials for some patients when the procedure was medically necessary.

Since the beginning, hundreds of ASCRS and ASOA members flooded Aetna leadership with personal stories, detailing the harmful impact of this policy on patients and their practices. ASCRS and AAO engaged in a joint public relations campaign with Schmidt Public Affairs that ultimately resulted in 200 targeted media placements inside the beltway and in media markets nationwide that helped educate the public about the negative impact this policy had on physicians, as well as the dangers of delayed and denied care for Aetna beneficiaries.

In addition, ASCRS and AAO held several meetings with Aetna leadership, questioning the policy’s necessity, detailing the difficulties with rollout and issues with compliance.

ASCRS also engaged with policymakers on the issue. ASCRS Government Relations Chair Parag Parekh, MD, participated in a roundtable discussion with CMS, detailing our concerns with Aetna’s prior authorization policy for cataract surgery and various issues with its implementation. Representative Mariannette Miller-Meeks, MD (R-IA), and Senator Rand Paul, MD (R-KY), both ophthalmologists, joined ASCRS in expressing concerns over this policy in letters sent to CMS. Congresswoman Miller-Meeks also wrote an op-ed published in The Hill. CMS, following letters from these lawmakers, sent a formal letter to Aetna, outlining concerns about the program.

“Almost a year to the day, I spoke about how I was sad and angry to have to cancel cases that were arranged months ago, delaying patient care, due to this poorly reasoned prior authorization policy,” Dr. Parekh said. “For the past year, it has been a challenge to grapple with this requirement when I saw patients needing cataract surgery, but the insurer ultimately decided on medical necessity. It has also been a burden from a practice management standpoint. I am glad to again have the authority, as the surgeon, to determine what is best for my patients and when.”

ASCRS continued, even in recent months, to hold meetings with CMS, expressing concerns of how management tools, like prior authorization, can be abused by insurers, and more specifically how Aetna’s policy continued to delay patients’ access to cataract surgery, putting them at risk for accidents due to depth perception issues.

“For the past year, ASCRS has been advocating, on behalf of its member surgeons, cataract patients, and the ophthalmic community as a whole, for Aetna to put a stop to its prior authorization requirement that delayed sight-restoring surgery and put patients at risk,” ASCRS Executive Director Steve Speares said. “We feel gratified that these efforts paid off and that Aetna has rescinded this policy in most states.”

For more details about ASCRS’ efforts on prior authorization reform, click here.

SOURCE: ASCRS Press release 

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