Cataract surgeries subject to prior approval for some in Georgia -- but not in other states

[Northeast Agent]

[EXTERNAL LINK] - Cataract surgeries subject to prior approval for some in Georgia -- but not in other states

Georgia eye doctors say the requirements are burdensome and don’t apply in most other states.

The problem began last year when Aetna started requiring prior authorizations for cataract surgeries in its Medicare Advantage plans across the country.

This summer Aetna rolled back the policy — except in Georgia and Florida.

 

[somarco]

Seems a bit excessive if you ask me.

Unless you are almost blind (which is the only time a doc recommends it), I don't know anyone who wants their eyeball sliced open to implant an artificial lens, just because it is covered by Medicare.

Unless Aetna and Humana do things differently, Medicare covers the basic IOL, monofocal lens. Doesn't matter if it is blade surgery or laser.

If you want an upgrade to multifocal IOL, EDOF IOL, accommodative lens or toric, you (patient) pay the difference vs a monofocal lens. I have a client, former pro golfer, who opted for the Panoptix IOL for roughly $5k per eye . . . his OOP cost above what Medicare + Medigap paid.