Humana Nurse Says Cataract Surgery Elective

Humana Nurse Says Cataract Surgery Elective

According to a Humana Nurse working in the South Florida area, cataract surgery is an elective surgical procedure. I am sorry but I cannot help but see the humor in that"Yes, I choose to see better please" funny. Seventeen years after a special congressional committee on aging announced that 74% of cataract patients demonstrated both functional and symptomatic improvement after having cataract surgery, a major healthcare carrier offering Medicare advantage programs still deems it "elective" or nonessential! As representative for my Aunt, I have been corresponding with Humana's Grievance and Appeal Department for nearly two months, requesting out-of-network approval for cataract surgery for an extremely dense cataract that was affecting the vision in my Aunt's right eye. She has an HMO Medicare advantage plan. You would think that by this time she would have received a phone call from Humana, but we had not received a verbal response to the initial request dated 21 October until December 9, 2010. At that time, a Humana nurse identifying herself as Linda contacted my Aunt; this despite numerous faxes sent by me naming myself as Power of Attorney and providing them with Humana's Authorization of Representative, and Consent Release form for healthcare information. My Aunt informed this nurse that her niece was handling discussion of her healthcare and gave the nurse my telephone number.

At this juncture, a little history is needed for an understanding of the situation. It appears that there is only one ophthalmologist that performs in-network cataract surgeries for Humana in the central Florida area. An employee of this office by the name of Brenda told me that a four-bed surgical facility was the only healthcare facility used by this ophthalmologist for cataract surgeries. They denied access to this facility to my Aunt because of her weight, and were making provisions for her to have cataract surgery at The University of Miami. My Aunt is disabled and making a six-hundred mile round trip for simple cataract surgery is ludicrous! So, I requested out-of-network authorization and here we are five months later waiting to be paid for one emergency cataract surgery that was performed on the right eye courtesy of my mother, and awaiting approval for another cataract surgery needing to be performed on the left eye, for you see the Humana ophthalmologist elected not to indicate these two on his evaluation. This is testament to Humana's philosophy that "cataract surgery is elective."

My mother knew that my Aunt's cataract surgery could not wait. She had experienced permanent double-vision from a large cataract herself, and came very close to losing the vision in the affected eye. In her case, coordination of the focus of her two eyes was affected. In simple terminology, the neural pathways running from the brain to the affected eye were miscommunicating. The brain says, "Do not try to see." Yet, Humana still labels cataract surgeryelective.

With cataracts being among the top causes of visual impairment in our senior citizens, surgery which restores vision to the point whereby driving ability, self-care, reading, and overall functionality is improved, correction by surgery is both significant and an essential obligation to the aged population's healthcare. To the Humana nurse that sought to educate me in cataract surgery, I say this, cataract surgery for the thousands, perhaps millions of those in America is not considered an elective surgery, but a necessary one, the technology of which has been purchased with their tax dollars, and a standard of medical care to which the aged of our society are entitled to.

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