Aetna said today that despite strong opposition from the American Society of Cataract and Refractive Surgery (ASCRS) and American Academy of Ophthalmology, it will require prior authorization for all cataract surgery procedures starting July 1.
Aetna officials, who announced this decision in a meeting with the two organizations, failed to provide concrete reasoning on why this policy is being implemented. Stating only that its internal data showed a less than 5% variation in medically necessary surgeries, Aetna neither gave actual examples nor presented any rationale for subjecting all cases to precertification.
ASCRS and the Academy will take further actions to get the policy rescinded and ensure patients’ access to medically necessary cataract surgery is not delayed or denied. We are disappointed with Aetna’s response; this policy puts patients at risk of losing vision and increases burdens on practices to an unacceptable level.
In addition to requesting clarification on the reasoning and scope of the policy, we raised transparency concerns, as no policy documents had been published and no prior education took place. We discussed concerns from our members on inconsistent instructions from Aetna staff and denials that practices already had received. We requested Aetna immediately withdraw the program to ensure patients receive access to timely cataract treatment.
Aetna not only declined to withdraw the program but refused to pause it. They also failed to address our concerns on the operational aspects of the program and offered no relief for the short implementation timeline, its inoperable portal, and unhelpful general support line that has resulted in complete confusion for members.
The immediate negative outcomes for patients are unacceptable.
Here’s what you need to know:
- The policy is effective July 1.
- The policy requires preapproval for all cataract surgeries: CPT codes 66982, 66984, 66987 and 66988.
- This applies for all sites of service and in all markets.
- Precertification requests should be submitted at least two weeks in advance.
- Requests can be submitted through Availity using the “Authorization (Precertification) Add” transaction or you can call 1-866-752-7021 for “guided” Aetna support.
- For Florida and Georgia Medicare-only patients, use the telephone numbers below:
Florida Medicare only (MEHMO and MEPOS), contact iCare at 1-855-373-7627
Georgia Medicare only (MEHMO and MEPPO), contact iCare at 1-844-210-7444
What you can do:
- If you have experienced any issues with getting approval, contact ASCRS government relations at email@example.com.
- Contact Aetna directly to express your opposition to this policy. Providers can call Aetna’s Availity support line at 1-866-752-7021.
- Physicians and administrators can email Scott Spradlin, Vice President Clinical Strategic Operations and Policy Delivery at Aetna, firstname.lastname@example.org, and Anil Goyal, MD, Aetna Medical Director, email@example.com.