![]() The American Academy of Ophthalmology has been pushing for change, and there is currently a bipartisan group of legislators in the United States Congress trying to put forth legislation that would improve and simplify this process for seniors. ![]() We understand that insurance coverage can be confusing and that the prior authorization process can be a burden. It is best to do so at least a month before the current one expires to help minimize any lapses in care or treatment. This allows you to be proactive in securing a new prior authorization. Keep detailed records of all prior authorizations and make note of when they expire.If your request is denied, be prepared to appeal the decision and know how that process works. If your request is approved, be sure to abide by any rules the insurance company provides for obtaining care.Double check that you meet all of the requirements and ensure that we have all of the necessary information before we submit the prior authorization.You should be able to find this on the plan’s website, or you can call the member services phone number found on the back of your health insurance card. If prior authorization is required, learn the process that your plan requires.Review your health plan’s policy documents to determine if any treatments or medications require a prior authorization.While our office is ultimately responsible for submitting the prior authorization request, here are a few steps you can take to stay informed and assist with the process: ![]() Please know that our team does all we can to assist you and expedite these prior authorizations to help you receive the care you need when you need it. Some Medicare Advantage plans even require prior authorization for each visit at our office as well as for each intravitreal injection, a common treatment for retina conditions like age-related macular degeneration. Unfortunately, the need for prior authorization can sometimes create a delay in receiving care. This means that the health plan has to provide you and us with approval before care is provided in order for the plan to cover the cost. In addition, many insurance plans, especially Medicare Advantage plans, are increasingly requiring a prior authorization for certain procedures and prescriptions. Some plans also require that you choose a physician in their network. Some health plans require a referral from your primary care physician to receive care from any specialist, including our physicians here at Texas Retina Associates. As we start a new year, it is important to understand how your specific plan works and how that can affect your retina care. Foveal ERG amplitude was significantly related to subsequent macular hole folmation, suggesting that this test can provide an objective measure of macular function to help identify eyes at risk for macular hole formation.Health insurance policies and coverage vary greatly. Four of these eyes subsequently developed a full-thickness macular hole during follow-up (mean follow-up, 35 months range, 25 to 46 months). Seven eyes had significantly reduced foveal cone ERGs in the fellow eye, despite good visual acuity and a normal-appearing macula on the initial visit. None of these eyes developed a macular hole. Twenty-six patients had normal foveal cone ERGs in the fellow eye at the baseline visit and for the duration of the study (mean follow-up, 35 months range, 24 to 56 months). Foveal cone ERG amplitude was significantly correlated with hole diameter at the initial visit.
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