1. Jul 05, 2021

American Academy of Ophthalmology and ASCRS Urge Aetna to Reverse Disruptive New Policy on Cataract Surgery

Aetna today is implementing a sweeping new policy that is a complete contravention of its stated commitment to build an "open health care model that will help consumers improve their health and simplify their health care experience."

Aetna, the country's third-largest provider of health insurance and services, is requiring pre-approval for all cataract surgeries starting July 1, 2021. Why has the insurer chosen to make it more difficult for each and every one of its beneficiaries to obtain this sight-restoring surgery?

The American Academy of Ophthalmology and ASCRS (American Society of Cataract and Refractive Surgery) have tried to get a clear answer, but Aetna provided no reason for creating a policy that no other large medical insurer believes necessary. The only justification Aetna has given is their own calculation that there is a less than 5 percent chance that they would deem a surgery unnecessary. Why disrupt and delay care for 95 percent of beneficiaries to address an issue that affects so few?

Here's what ophthalmologists do know: Visual impairment due to cataract is real. Cataracts reduce our patients' quality of life, interfere with their work, and puts them at increased risk for falls and car accidents.

About 4 million Americans undergo cataract surgery every year, a number that will grow as our population ages. There's almost no other surgery as effective and transformative as cataract surgery. It allows people to recover their lives. We have asked Aetna to immediately withdraw the program. They have declined to even pause it until physicians and patients can be educated on it.

Because Aetna published no updated policy documents and provided limited prior education, the new policy is already causing chaos at the doctor's office. This at a time when ophthalmology practices are struggling to fit patients in as they work through a backlog of surgeries due to COVID-19 shutdowns.

Ophthalmologists have reported that phone calls to Aetna for additional information have been met with mixed messages. Some have been told approval will be instant, while others have been told it could take up to 14 days. Some have been told to cancel all surgeries for the first two weeks of July, while others have been told there is no new policy. The policy has been implemented in such an inefficient manner that we estimate that 10,000 to 20,000 Aetna patients will have their cataract surgery unnecessarily delayed in the month of July alone. Just yesterday, a confused patient called their ophthalmologist in anger to blame him for cancelling surgery. One day before the effective date, and it's already threatening to erode trust between patients and physicians.

There must be a better way to solve this unstated issue Aetna wishes to fix; a way that helps consumers improve their health and simplify their health care experience. The nation's ophthalmologists are committed to finding a solution that does not delay or deny our patients access to vision-restoring surgery.

Source: American Academy of Ophthalmology