Aetna will roll back a broad pre-certification policy for cataract surgeries that it launched last summer, the insurer tells Fierce Healthcare exclusively.
Under the program, Aetna required prior authorization for all cataract surgeries beginning on July 1, 2021. The policy was later modified amid outcry from ophthalmologists and other eye care experts, who urged the insurer to fully remove the requirements.
In a statement to Fierce, Aetna said that the program will be discontinued as of July 1, and that it chose to do so after gathering real-time data on cataract surgeries. The insurer regularly reviews and updates policies like this one, Aetna said in its notice (PDF).
"Going forward, we will focus on retrospective reviews of procedures and providers where questions of medical necessity exist," Aetna said in the statement. "We regularly evaluate and update our clinical policies and processes to help ensure our members are provided with the best care. This decision supports that practice."
Ophthalmology experts said last year that the policy could make it significantly harder for patients to access cataract surgery and that delays could lead to worse outcomes, including blindness.
The American Society of Cataract and Refractive Surgery said in a statement last July that Aetna met with the group and the American Academy of Ophthalmology to explain the policy, but "failed to provide concrete reasoning."
"A prior authorization requirement will delay surgery, will put patients at higher risk, and will alienate patients and physicians,” said Steve Speares, ASCRS executive director, in the statement.
Prior authorization policies like this are a consistent source of friction between payers and providers. Insurers argue that pre-certification measures are key to managing cost and utilization of unneeded services, while providers say it can lead to harmful delays and mounting administrative burdens.
Ophthalmology groups cheered Aetna's decision to roll back the policy.
“Aetna’s decision to impose a prior authorization requirement for cataract surgery was very difficult to understand since the indications for surgery are well established and the benefits clear,” said Stephen McLeod, M.D., CEO of AAO, in a statement.
In the statement, the academy reiterated its support for bipartisan legislation in Congress that would add guardrails for prior authorization.