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Anthem's Cataract Surgery Anesthesia Guidelines

Update - Anthem's Cataract Surgery Anesthesia Guidelines

Many of you have contacted the OOS offices and we had an extensive discussion at our Annual Meeting about Anthem’s new guidelines related to anesthesia provided during cataract surgery. This recent policy change has caused great concern and confusion across the state. The OOS has spent several weeks working with our state and national partners to assess how these guidelines will be implemented in Ohio while at the same time strongly urging for the policy change to be rescinded altogether.

We wanted to provide you with an update of our efforts and clarify the status of the applicability of the guidelines in Ohio. First, since these guidelines were created at the corporate level at Anthem, we have been working closely with the American Academy of Ophthalmology and impacted state ophthalmology societies to coordinate our advocacy efforts. This has resulted in joint communications. Additionally, last week we spoke directly with a representative from Anthem and confirmed specifically how the changes will impact Ohio. Assuming Anthem does not withdraw the guidelines, we made the following request and clarified implementation questions:

  • The OOS requested a meeting between some ophthalmologists on our Board and the physicians/clinicians that developed the policy to provide the opportunity for our doctors to articulate their concerns with the existence of the policy and the definition of medical necessity as outlined. We are waiting to hear back on that request.
  • The guidelines are currently not being applied in any state for claims processing and thus no payment of claims should be impacted in any way at this point.
  • The guidelines don’t apply to Medicare Advantage Anthem patients – they relate to commercial plans only.
  • Any implementation of the policy in the future would require a 90-day notice to providers because it would be a material change to the contract – therefore it would only apply to claims filed going forward and shouldn’t be applied retrospectively prior to that date.

In summary, in terms of practical application today the guidelines as written do not currently impact services or claims being processed in Ohio. But if that were to change it is our contention that practices should receive at least a 90-day notice and the change would only impact commercial coverage. These clarifications certainly help with our immediate concerns, however, our ultimate goal is to fully rescind the policy and we will continue to advocate to make that happen. As always if you have any questions, please contact the OOS office at

-OOS Board of Governors

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