According the AAO, in a meeting with national Aetna officials, the insurer "failed to provide concrete reasoning on why this policy is being implemented. They only stated that their internal data showed there was less than a 5% chance that they would deem a surgery unnecessary."
If true, that translates into the fact that nearly 95% of these requests will be approved, making this an exercise in futility for the vast majority of cases. In fact, given the standard for performing cataract surgery is fairly clear-cut, it would seem the "rejections" would more likely to be from paperwork errors than inappropriate surgery.
CAEPS is working with the AAO to send a strong message to Aetna that this new requirement is irrational and will disrupt not only surgical scheduling but the patient-physician relationship, and will do nothing but cause unnecessary delays.
Please use this driver to send an email to key California decision makers asking them to work to overturn Aetna's decision.