Nation’s Ophthalmologists Urge Congress to Protect Patients From Health Insurer Policy Disrupting Medically Necessary Care Across the Country

SAN FRANCISCO, July 29, 2021 /PRNewswire/ -- Today, the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery, representing 20,000 medical doctors in the United States, sent a letter to members of Congress, asking for support in our ongoing effort to rein in excessive prior authorization requirements imposed by insurers. These policies take control of medical decisions from doctors and put them in hands of insurance company administrators who delay and disrupt, and sometimes deny medically necessary care.

The most recent and egregious example of this problem is a new policy implemented by Aetna that requires prior authorization approval for all cataract surgery starting July 1, 2021. The new policy applies equally among its members, from children born with cataracts, to adults whose cataracts interfere with their ability to drive, to people in need of emergency cataract surgery before vision-threatening retinal conditions can be treated.

Cataract surgery is one of the most effective and common procedures performed in all of medicine with some 4 million American choosing to have cataract surgery each year and an overall success rate of 97 percent or higher. And yet Aetna has put this successful, long-established procedure through a new algorithm known only to the insurer and determined that some these surgeries are unnecessary. Aetna has provided the Academy and ASCRS with no plausible reason for creating a policy that no other large healthcare insurer believes necessary.

When prior authorization policies began to take hold about 20 years ago, it was intended to focus on specific new drugs and diagnostic tests. But over the years, the practice has expanded to common procedures and surgeries, ensnarling physicians and patients in red tape, delaying care and putting patient's health in peril. It's not even clear that insurance companies save money in the long run because after all the delays and hassle, most of these surgeries are approved anyway.

A survey by the American Medical Association found that 94 percent of doctors report that their patients have experienced delays in care due to prior authorization. Some 30 percent of doctors say that the prior authorization process has led to a serious adverse event of a patient in their care.

The Academy and ASCRS are asking members of Congress to support our efforts to ensure patients have timely access to sight-restoring care by urging Aetna to rescind their policy. We also urge members of Congress to cosponsor H.R. 3173, the Improving Seniors' Timely Access to Care Act. This bipartisan legislation seeks to improve the prior authorization process in the Medicare Advantage Program by increasing transparency, streamlining processes, and minimizing the use of prior authorization for services that are routinely approved.

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SOURCE American Academy of Ophthalmology