In a letter to UnitedHealthcare, the American Academy of Ophthalmology (AAO) requested UnitedHealthcare include ophthalmic services in its new “gold card” program the health-care insurer has designed to reduce administrative burdens on physicians and office staff.

According to AAO, the gold card program exempts eligible practices from having to request prior authorization for certain procedures in UnitedHealthcare's in-network plans. However, the payer’s initial rollout of the program does not include any ophthalmology services.

Currently, UnitedHealthcare commercial and individual exchange plans require prior authorization in the hospital outpatient setting (HOPD) for more than 100 ophthalmology codes, including cataract surgery; its Medicare Advantage plan requires site-of-service prior authorization for a limited number of eye surgery procedures. While the policy is intended to incentivize most procedures to be performed in an ASC setting, AAO notes that many rural ophthalmologists lack access to a nearby ASC equipped for many ophthalmic procedures; additionally, many patients have procedures requiring treatment in an HOPD setting.

The result is an ongoing administrative burden of requesting prior authorization on ophthalmology practices, AAO explains, "even though UnitedHealthcare already has records of a patient’s status and the physician’s ASC access. "Our letter calls on UnitedHealthcare to put an end to redundant site-of-service prior authorizations by extending its gold card program to include applicable ophthalmology practices and procedures," AAO stated in a press release.