Aetna rescinds prior auth requirement for most cataract

July 11, 2022

Aetna recently announced it will no longer require pre-approval for most cataract surgeries. This decision came a year after Aetna implemented a policy requiring all cataract surgeries to be “pre-certified,” claiming that it would “help members avoid unnecessary surgery.”

The California Medical Association (CMA) and others in organized medicine strongly objected to this policy, which created unnecessary delays and obstacles for patients and physicians, reducing availability of health care services and increasing insurance company profits at the expense of patient care.

An estimated 10,000 to 20,000 Aetna beneficiaries had their cataract surgeries unnecessarily delayed in just the first month after Aetna’s prior authorization requirement took effect, according to the American Academy of Ophthalmology (AAO).  

Aetna’s pre-authorization policy was just one in a trend of insurance companies that are incorporating hurdles for patients and physicians, which place significant new administrative burdens on physician practices and create serious and dangerous delays in care for patients. A recent American Medical Association (AMA) physician survey showed that 9 in 10 physicians say that prior authorization programs have a negative impact on patient clinical outcomes.

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 supporting legislation at the state and federal levels that would streamline and standardize prior authorization requirements.

CMA is supporting federal legislation—HR 3173, the “Improving Seniors’ Timely Access to Care Act” authored by California Congressman Ami Bera, M.D.—that seeks to standardize and streamline prior authorization processes for routinely-approved items and services performed under Medicare Advantage programs, among other improvements.

Closer to home, CMA is also sponsoring a California bill—SB 250 by Senator Richard Pan, M.D.—which would streamline the prior authorization system to ensure patients have access to the care they need without unnecessary delays. This bill recently passed the Senate and is working its way through the California State Legislature.