Aetna reverses policy requiring pre-approval for cataract surgery


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Starting July 1, Aetna will no longer require prior approval for cataract surgery except for patients in Florida and Georgia who are enrolled in Medicare Advantage, according to a press release from the American Academy of Ophthalmology. .

The announcement comes after Aetna implemented a policy that required pre-approval for all doctor-ordered cataract surgeries in July 2021. According to the release, approximately 10,000 to 20,000 cataract surgeries among Aetna beneficiaries were delayed in July due to politics.

“Aetna’s decision to require prior authorization for cataract surgery was difficult to understand because the indications for surgery are well established and the benefits clear,” Stephen D. McLeod, MD, CEO of the AAO, said in the release. “And the immediate impact on patients being subjected to unnecessary delays should have been obvious: this is an incredibly common procedure with some 4 million Americans undergoing cataract surgery each year. It has an extremely high success rate in terms of safety and improved vision, and studies have consistently shown that cataract surgery improves quality of life, reduces the risk of falls and car accidents and is associated with reduced cognitive decline in the elderly.

It remains unclear why Medicare Advantage beneficiaries in Florida and Georgia are excluded from the policy reversal, according to the statement.


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