Aetna Ends Preapproval Requirement for Cataract Surgeries in Georgia
In a significant victory for the ophthalmology community, Aetna has officially announced the cessation of preapproval requirements for cataract surgeries for Medicare Advantage beneficiaries in Georgia, effective January 1. This decision comes after two years of dedicated advocacy from ophthalmologists and medical organizations.
The announcement was confirmed through a letter sent by Aetna to the American Academy of Ophthalmology (AAO), acknowledging the persistent efforts of the ophthalmology community in Georgia. This change means that Medicare Advantage beneficiaries in Georgia will no longer face the burden of obtaining preapproval for cataract surgeries, streamlining access to essential eye care services.
“The Georgia Society of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Academy worked together on a sustained advocacy campaign to get Aetna to drop its onerous cataract surgery policy in Georgia,” Stephen D. McLeod, MD, CEO of the Academy, said in an AAO news release. “We have now succeeded in protecting patients in 49 states, but the job is not yet done. We will redouble our efforts to protect Floridians, in partnership with the Florida Society of Ophthalmology. At the same time, we will continue to pressure Congress to pass legislation that will help ensure our nation’s seniors continue to receive the high-quality, timely care they deserve.”
However, it's worth noting that last year, Aetna rolled back the preapproval policy for cataract surgeries for Medicare Advantage patients in all states except Georgia and Florida. Unfortunately, the recent rollback does not include Florida, prompting the AAO to intensify its efforts to overturn what it describes as an 'abusive and dangerous' policy in the state.
"The Georgia Society of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Academy worked together on a sustained advocacy campaign to get Aetna to drop its onerous cataract surgery policy in Georgia," said Stephen D. McLeod, MD, CEO of the Academy. "We have now succeeded in protecting patients in 49 states, but the job is not yet done."
Dr. McLeod emphasized the ongoing commitment to safeguarding patients in Florida, collaborating with the Florida Society of Ophthalmology. Simultaneously, the AAO plans to exert pressure on Congress to pass legislation aimed at reforming prior authorization for all Medicare Advantage plans nationwide.
The ophthalmology community engaged with the Centers for Medicare & Medicaid Services (CMS), seeking increased oversight. Additionally, members of the Georgia and Florida U.S. Congressional delegations urged CMS to scrutinize Aetna's policy. Concurrently, bipartisan Congressional leaders worked alongside the ophthalmology community to advance legislation addressing prior authorization concerns.
Medicare Advantage plans now enroll approximately 31 million people, constituting just over half of all Medicare beneficiaries, according to the Kaiser Foundation. The surge in enrollment has coincided with growing dissatisfaction among physicians, hospitals, and patients regarding claim denials and preapproval requirements.
The AAO noted an increasing trend of hospitals and physician practices refusing to accept Advantage plans due to these issues. The recent decision by Aetna to lift preapproval requirements in Georgia aligns with the broader movement within Congress to enhance oversight and transparency, protecting beneficiaries from unnecessary care delays and denials.
