COLUMBUS, Ohio — Dr. Alice Epitropoulos, a board-certified ophthalmologist, who specializes in cataract surgery, recently had a check-up with patient Robert Miller after his second cataract surgery.
Although she said things are looking great for Miller, Epitropoulos said for the industry in general, times have changed for cataract surgery patients.
She said Miller is one of more than a dozen of her patients who were initially denied health care coverage.
“As a board certified ophthalmologist, I have taken an oath to do no harm, and I am speaking out on behalf of my patients and thousands of others who have experienced the stress and the disappointment of this delay and denial policy,” said Epitropoulos.
In July, Aetna, one of the nation's largest insurance carriers, initiated a new "Prior Authorization" policy for cataract surgery patients. Under this policy, some care will require doctors to get approval from the health insurance agency before performing certain procedures or services. This does not apply to emergency services.
Common services that will require pre-approval include overnight hospital stays, major surgeries, special visits, expensive medications and more.
A recent study by the American Academy of Ophthalmology found the new policy has delayed cataract surgery for up to 20,000 patients alone in July of this year.
“Everything was blurry — freeway signs. I couldn't see,” said Miller.
Miller had already been approved and had successful cataract surgery on his left eye, but a night before he was scheduled to have the same surgery on the right eye, Aetna denied it saying Miller was not ready for a second surgery.
After hours on appeal by the office, the decision was reversed and Miller did finally receive his surgery in two weeks' time.
“I have no idea why an insurance company is involved in somebody having to postpone surgery, especially after the left one had been done, and successfully. I could tell the difference immediately," said Miller.
A representative from Aetna released a statement that in part reads:
“Based on our decades of experience in reducing unnecessary surgeries, a multi-year, multi-state pilot on reducing unnecessary cataract surgeries, and national clinical guidelines and literature on surgeries, we believe up to 20% of all cataract surgeries may be unnecessary. Our data since launching the program in July shows that more than 99% of cataract precertification cases were compliant with turnaround time standards, which are based on regulatory and accreditation requirements.”
Epitropoulos disagrees with Aetna's statement and said the denial of one patient is one too many.
She calls on action from the state and national levels to end this practice. And until then, she and her staff will continue to fight for patients' rights.
“Good news is there is federal legislation that's gaining steam in D.C. — Improving Seniors Timely Access To Care Act — and many in Ohio's Congressional Legislation have supported this. And again, I think that we need to call for Aetna to redact this dangerous policy, and stop putting profit over patient care,” said Epitropoulos.
Ohio Sen. Sherrod Brown introduced the Improving Seniors Timely Access to Care Act in the Senate. The House version has the support of 280 members.
Cataract surgery is the most common and most successful procedure that's performed, with over a 99% success rate, according to UCI Health.
More than 4 million American seniors receive cataract surgery each year, according to the National Institutes of Health.
For more on Aetna's Prior Authorization Policy, tap here.