Insurance company policy denies patients eye-saving surgery

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If your vision deteriorated so much that you had difficulty working or driving safely, would you do all you could to regain your sight?

Of course you would.

And as certified ophthalmologists, we are sworn to do everything in our power to ensure that patients receive the medical care they need, when they need it.

Megan Chambers is a Certified Ophthalmologist and Fellowship-trained Glaucoma Specialist serving patients throughout central Ohio.

When we entered the profession, we couldn’t have predicted just how abusive insurance companies would become, or how they would take control of doctors’ medical decisions and put them in the hands of company directors. insurance that would delay, disrupt and sometimes refuse to be medically necessary. care.

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About 4 million Americans have cataract surgery each year.

It is one of the most common and life changing procedures.

It allows people to see more clearly and resume the activities of daily living. Even though cataract surgery is safe, effective, and transformer, Aetna – one of the country’s largest insurers – has put up unreasonable barriers to this sight-saving treatment.

Aetna has told tens of thousands of Americans who have faithfully paid their premiums that their cataracts “aren’t bad enough” and that their vision needs to get worse before the insurance company covers their doctor’s recommended surgery. A practice called prior authorization gives Aetna this extraordinary power over medical decision-making.

Alice Epitropoulos is a certified ophthalmologist specializing in cataracts, refractive surgery and has a center of excellence for dry eye.

Aetna launched a disturbing new pre-authorization policy on July 1This applies to all cataract surgeries, even when patients are faced with emergency situations. This new policy ignores nationally recognized clinical guidelines on cataract care and endangers patient health and safety.

Unless Aetna says so, we cannot perform surgery even when cataracts interferes with the work of patients and puts them at increased risk for falls and car accidents.

This absurd policy has already caused 10,000 to 20,000 surgeries to delay or cancel in the first month only. We are still fighting with Aetna over one of our patients who came to see us in June. She needs surgery for cataracts and severe glaucoma.

Because vision loss from glaucoma is irreversible, surgery cannot be delayed. Often times, these two eye conditions are treated at the same time, as this gives the patients the best chance of getting a good result. But here we are, almost five months later, and Aetna still hasn’t approved cataract / glaucoma surgery.

Normally the pre-certification process takes less than 15 minutes, but our staff spent around 15-20 hours trying to get coverage for this one patient. She is only in her sixties and has a lot of life to live on. For Aetna, dismissing all calls and waiting for her vision to get even worse before covering up for her surgery is insensitive and ignores the standard of care for patients with cataracts and glaucoma.

Recognizing the damage caused by certain pre-authorization requirements, Congress is working to pass a bipartisan bill that protects patients. The An Act to improve access to timely care for the elderly is designed to put safeguards around pre-authorization in Medicare Advantage insurance plans.

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The bill already boasts 246 co-sponsors in the House — much more than the 218 needed to pass—including 10 representatives from Ohio. It was just presented to the Senate at the end of October, and our own Senator Sherrod Brown spearheaded a letter to Medicare urging it to modernize and streamline pre-authorization under the bill.

As we strive to ensure our patients get the coverage they pay for, we encourage the entire Ohio Congressional delegation to join us. It’s time to protect patients’ access to vision-saving surgery by preventing insurance companies from going too far.

Dr Alice Epitropoulos is a certified ophthalmologist specializing in cataracts, refractive surgery and has a center of excellence for dry eye.

Dr Megan Chambers is a Certified Ophthalmologist and Fellowship-trained Glaucoma Specialist serving patients throughout central Ohio.


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