Anthem put out new guidelines stating anesthesiologists are not medically necessary in cataract surgery in most cases.
What do you mean “most cases”?
Unless the patient is “less than 18 years of age, unable to cooperate or communicate, unable to lie flat (for example, severe back pain, congestive heart failure), an individual who has failed or has contraindications to topical, local, regional, or moderate sedation anesthesia, or if there is anticipation of prolonged or complex surgery”, an anesthesiologist is not needed.
How do ophthalmologists feel about this change?
Not great. Several physician groups have written Anthem asking them to redact the policy change. One ophthalmologist said, “an ophthalmologist cannot administer conscious sedation and monitor the patient and do cataract surgery at the same time”.
This change has left some practices asking Anthem patients to pay out of pocket for the anesthesia services, a cost that is around $400. (via)
