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Aetna policy change requires preapproval for cataract surgeries

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Aetna began requiring that healthcare providers get preapproval for all cataract surgeries July 1.

The insurer did not publish updated policy documents before implementing the policy, according to a statement from the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, which means some ophthalmologists have had to cancel cases until they can get approval.

The joint statement from the two industry groups said some ophthalmologists were told to cancel surgeries for the first two weeks of July until the procedures could be preapproved, while others were told there was not a policy update. The groups estimate 10,000 to 20,000 Aetna members could have their cataract surgeries delayed in July due to the policy change.

Aetna told the ophthalmology organizations there is less than a 5 percent chance they will deem surgeries unnecessary during the preapproval process. The ophthalmology organizations oppose the policy change.

The preapprovals could make cataract surgeries in ASCs more challenging because it will take longer to schedule those cases. About 36 percent of all ASCs include ophthalmology, and 25 percent of single-specialty ASCs are devoted to eye surgery, according to MedPAC's 2021 report to Congress. 

Cataract surgery with intraocular lens inserts is the most common procedure performed in ASCs, making up 18.5 percent of all surgeries performed at surgery centers. 

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