AETNA ANNOUNCES NEW POLICY: OPHTHALMOLOGISTS MUST GET PRE-APPROVAL ON ALL CATARACT SURGERIES, effective July 1, 2021.

Aetna recently announced that starting on July 1, 2021, it will require preapproval for all cataract surgeries in ambulatory surgery centers and outpatient departments. 

AAO, ASCRS, and OOSS have been representing the concerns of ophthalmologists  explaining that preapproval would cause delays and disruption in sight-saving patient care.  It would also place unnecessary administrative burdens on ophthalmic practices and ambulatory surgery centers.  Aetna, which has a large share of Medicare Advantage business, has never required precertification for cataract surgery. 

Aetna is placing cataract surgery on the National Precertification List to allow the insurer to review for medical necessity. Aetna’s justification for this policy change is that it will help their members “avoid unnecessary surgery”.

We share your concerns about this atypical prior authorization requirement and the effects it will have on patient care.  The associations will take actions to ensure that patients’ access to medically necessary cataract surgery is not delayed or denied.

The ophthalmic community will continue to advocate for our patients and lobby Aetna to withdraw its misguided policy.

Should you have any questions, please contact OOSS Washington Counsel, Michael Romansky, JD at mromansky@OOSS.org.