Aetna recently announced that it will no longer require pre-approval for most cataract surgeries. The move came a year after Aetna instituted a policy requiring all cataract surgeries to be “pre-certified”, saying it would “help members avoid unnecessary surgery”.
The CMA and other players in organized medicine strongly opposed this policy, which created unnecessary delays and hurdles for patients and physicians, reduced the availability of health care services and increased company profits. insurance at the expense of patient care.
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I am pleased to report that LACMA has a team of physician leaders led by Dr. Robert Bitonte, representing solo and small medical practices, who are exploring specific, meaningful, and tangible ways to apply good policy and to reduce or even eliminate prior authorization requirements. As LACMA head Dr. Sam Fink says, “Patients have many advocacy groups that can fight on their behalf, and usually patients end up being approved for the treatment, test, or procedure they are looking for. But I and my staff are overwhelmed with paperwork and meaningless phone calls, even for simple medications and tests.
Dr. Fink points out that the amount of paperwork imposed on physicians takes him and his staff away from patient care. “Neither my staff nor I have time for this nonsense. It limits the number of patients I can see in a day, limits the time I spend with them, and exhausts my staff to no end. I’m sure there were times when I didn’t order a test or prescribe a certain medication just because I didn’t want to commit my office resources to fighting a dumb battle,” Fink said.
We must and we will do more. In the weeks to come, not months or years, members will see more than effort, but a sustained fight with legislative teeth, and our elected leaders will “walk in the shoes” of a physician in private practice” to truly understand how administrative burdens lead to burnout and missed opportunities with patients.