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WellMed Alters Policy on Risk Discussion in Pre-authorization Requirements

This Webnews updates a news item posted on our website on May 14, 2020.  In January, 2020, WellMed sent providers in Florida and Texas notification of a change to the prior authorization process for many procedures, including cataract surgery and YAG laser capsulotomy.  This change to the WellMed prior authorization process was going to require patients to obtain counseling from their primary care providers (PCP) regarding the risk of certain elective surgeries during the current public health emergency.  WellMed stated that it had planned to contact the PCP to confirm that the counseling has occurred prior to granting authorization for the procedures.  Thankfully, WellMed first delayed, then completely reversed, this onerous new requirement.

On May 27, 2020, the American Academy of Ophthalmology (AAO) informed its members of a letter from WellMed, which noted that they would “remove the requirement that the [primary care physician] conduct the shared decision-making discussion and [WellMed would] accept documentation of that discussion from either the PCP or the specialist.”

If you receive notices from WellMed speaking to this specific addition to the Prior Authorization process, you should point out that the policy was rescinded – and is not in force.  We feel certain that the general requirement for Prior Authorizations for certain elective surgeries otherwise remains in force for WellMed, and that only this requirement that the PCP conduct the discussion is removed.  Be sure your chart documents this discussion to ensure compliance with the policy.

We are available and happy to assist you with issues such as this and other topics related to eye care during this public health emergency.  Stay safe.

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