Newswise — SAN FRANCISCO, Calif. – After two years of advocacy from the ophthalmology community, Aetna confirmed in a letter to the American Academy of Ophthalmology last week that it will no longer require pre-approval for cataract surgeries for Medicare Advantage beneficiaries in Georgia, starting Jan.1. Last year, the insurer rolled back the policy for everyone except Georgia and Florida Medicare Advantage patients. Disappointingly, last week’s rollback did not include Florida. The Academy will continue efforts to overturn Aetna’s abusive and dangerous policy on cataract surgery in Florida, while it also presses for Congressional action on legislation to reform prior authorization for all Medicare Advantage plans across the nation.
“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. 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.”
The ophthalmology community met with the Centers for Medicare & Medicaid Services to request increased oversight. Members of the Georgia and Florida U.S. Congressional delegations also called on CMS to conduct oversight of Aetna’s policy. At the same time, the ophthalmology community worked with bipartisan Congressional leaders to advance common-sense legislation that puts guardrails around prior authorization.
Medicare Advantage plans now enroll about 31 million people, representing just over half of everyone in Medicare, according to the Kaiser Foundation.
As enrollment has grown, so has outrage at insurance companies’ handling of Medicare Advantage plans. Physicians, hospitals, and patients complain of increasing claim denials that defy medical standards and burdensome preapproval requirements. Some hospitals and physician practices have refused to accept Advantage plans, even those offered by large insurance companies, such as United Healthcare and Humana.
Momentum is building within Congress to provide oversight and transparency while protecting beneficiaries from unnecessary care delays and denials. Last year, the Health and Human Services Department’s inspector general published a report that found some Advantage plans have denied coverage for care that should have been provided under Medicare’s rules. This report spurred Congressional hearings on Medicare Advantage plans delaying and denying medically necessary care.
“We will build on this momentum in Congress and continue to amplify the voices of our patients across the country who were inconvenienced and harmed by unnecessary care delays and ophthalmologists whose practices struggle to surmount waste, inefficiency and ever-increasing costs,” Dr. McLeod said. “Our patients and our physicians can’t wait any longer for relief.”
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