ATLANTA – Peggy Mitchell, 71, was having trouble driving at night, so she knew she could not wait any longer to have the cataract clouding her right eye removed.
The lively Alpharetta resident had scheduled her surgery for Nov. 22, before Thanksgiving, and arranged for a friend to drive her to the surgery and back home. She had already had a cataract on her left eye removed the prior year without a hitch.
But her carefully laid plans ground to a halt at the last minute when her Medicare Advantage insurer, Aetna, denied approval for the routine, vision-saving surgery most older adults need at some point.
Mitchell and her doctor appealed the denial but did not receive a response in time, forcing Mitchell to postpone the procedure for more than a month, until after Christmas. Mitchell’s ophthalmologist, Dr. Susanne Hewitt of North Fulton Eye Center, came into the office during her Christmas vacation to perform the surgery for Mitchell and others.
What’s unusual about this situation is that Aetna Medicare Advantage requires prior approvals for cataract surgery only in Georgia and Florida – not in other states. Aetna Medicare Advantage plans covered 132,414 Georgians in 2022, according to the Kaiser Family Foundation (KFF).
Humana instituted a similar policy—only in Georgia—last fall. Humana Medicare Advantage plans covered 264,010 Georgians last year, according to KFF.
In contrast to the plans’ Georgia policies requiring approvals, traditional Medicare – not run by insurance companies — does not require prior authorizations for most procedures, including cataract surgery.
Ophthalmologists and patients say Aetna and Humana’s policies delay care, put Georgia seniors at risk, and create burdensome administrative requirements, only for the surgeries to be approved in the end.
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