Aetna recently added cataract surgery to its national prior authorization list effective July 1, 2021, for all lines of business, including Medicare Advantage plans, and all sites of service. Aetna’s new prior authorization requirement is part of a trend of insurance companies that are incorporating hurdles for patients and physicians, which result in delays of medically necessary care and place significant new administrative burdens on physician practices.

Since the implementation of Aetna’s new cataract surgery prior authorization policy, the American Academy of Ophthalmology has received reports from ophthalmologists about how Aetna’s new policy is causing delays and denials in medically necessary care for patients and significant amount of practice time to obtain approvals. Some practices have reported spending 45-90 minutes on the phone to obtain a prior authorization. Other practices reported that because Aetna requires a separate prior authorization request for a bilateral procedure of the left and right eye, the payor is sometimes denying the request for one eye as a duplicate of the other eye and one practice reportedly had to cancel a week of cataract surgeries after failed attempts to obtain prior authorizations.  

The California Medical Association (CMA) continues to fight for medical decisions to be made by trained medical professionals, instead of lay entities that are more concerned with the corporate bottom line than the quality of patient care. This is why CMA is fighting to strengthen the prohibition on the corporate practice of medicine, and why we are supporting legislation at the state and federal levels that would streamline and standardize prior authorization requirements.

CMA is interested in hearing from ophthalmology practices that have experienced difficulties with Aetna’s prior authorization of cataract surgical services process. If your practice has run into any problems with the process, including submission of the preauthorization form to Aetna, multiple requests for medical records from the payor, or delays of medically necessary care for urgent cases, please contact CMA at economicservices@cmadocs.org or at (888) 401-5911 to share your experience.