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Aetna sees the light (finally)

Prior authorizations are a controversial topic in healthcare — especially in the eyes of those needing cataract surgery.

Has a health insurer actually seen the harm their restrictive policies cause for patients?

According to a recent article in Fierce Healthcare, Aetna is coming to terms with the fact that last summer’s prior authorization policy maybe wasn’t their best.

In case you missed it…

Last July, if you were an Aetna patient with vision problems and in need of cataract surgery, that surgery would have most likely been delayed. That’s because the health insurance company enacted a new policy on July 1, 2021, requiring prior authorization for all cataract surgeries.

The move was met with disdain and protest from nearly every medical association with a vision-focus. The American Academy of Ophthalmology (AAO) and American Society of Cataract and Refractive Surgery (ASCRS) asked Aetna to immediately withdraw the new rule. The policy, they reasoned, would lead to complications for patients, including difficulty performing everyday tasks due to poor visual acuity, increased risks of falls and car accidents, and decreased quality of life.

Aetna held fast, at least for a few months. At the time, the insurer said up to 20% of cataract surgeries were unnecessary. And get this: the statistic was based, of course, on their own data.

Even if that stat were true, that’s a whole lot of hoops to make 80% of patients go through, especially when delayed cataract surgery increases the risk of reduced visual acuity, poorer surgery outcomes, and comorbid retinal disease.

Now, according to Fierce Healthcare, “Aetna said that the program will be discontinued as of July 1st, and that it chose to do so after gathering real-time data on cataract surgeries.”

So, did the data change dramatically in the span of a year? Or did Aetna suddenly realize that nobody really wants to undergo eye surgery unless it’s medically necessary? Or, as we suspect, did Aetna know that all along, and just hoped to save some cash by making necessary care harder to access?

Original Article:

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