Skip to Content

Aetna members might need to start sleeping with one eye open

Aetna has its eyes on cataract surgeries – and not in a way that benefits its members, according to an August 5 article in AJMC.

Vision can be an overlooked element of health. But not for Aetna, who launched a new policy requiring prior authorization for all cataract surgeries as of July 1.

Per a recent article in The American Journal of Managed Care, the insurer claims that “up to 20% of cataract surgeries are unnecessary.” Cool, who says? Well, Aetna does. And of course, the article reports these calculations are based solely on their own data (surprise, surprise).

Sure, we’re willing to accept that some cataract surgeries may be unnecessary, but would we bet our vision on that? Absolutely not.

But while Aetna may not have your back, your providers do. Ophthalmologists are in huge disagreement with Aetna’s new protocol for surgeries. There’s so much uproar that the American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgery (ASCRS) have asked Aetna to immediately withdraw the program, as they believe the policy will only lead to complications for patients seeking cataract surgery.

The article also points out that the pandemic created a backlog of almost a quarter of a million cataract surgeries. Was this policy put in place to limit surgeries now that care volumes are poised to return, despite protest from physicians?

Extending the time that patients must wait for cataract surgery will lead to further complications, physicians say, including difficulty performing everyday tasks due to poor visual acuity, increased risks of falls and car accidents, and decreased quality of life. Delays also drive the risk for permanently reduced visual acuity, poorer surgery outcomes, and comorbid retinal disease.

With consequences like these, we wonder just how factual that 20% figure is. Suffice to say, we’d like to see the math.

Original Article:

Subscribe to Un-covered Essentials

Your payor relations plan is only as good as your knowledge of industry trends—stay informed with our bi-weekly newsletter.