Policyholder Services

I performed cataract surgery with a premium IOL on my patient’s right eye, and the patient is now anisometropic. Can I perform RLE on the other eye?

Lens exchange performed on patients with visually significant cataracts is considered cataract surgery for coverage purposes. Therefore, no special endorsement nor underwriting requirements apply. If you feel your patient’s cataract OS requires extraction, you may proceed with surgery at your discretion as soon as the patient is stable.

If the cataract in the left eye is not visually significant or if the eye is not cataractous, treatment of the left eye would be considered refractive lens exchange (RLE) subject to OMIC’s refractive surgery requirements for this procedure. Your policy must be endorsed for coverage of refractive lens exchange (endorsement OMC132I), and the patient must fall within OMIC’s established patient selection criteria. If the patient falls outside of OMIC’s underwriting requirements, you may request a patient-specific exception by providing details regarding the patient’s pre-operative condition and the rationale for seeking an exception. An Exception Request Form for Coverage for Refractive Lens Exchange is available for download to assist you in this process. Please allow OMIC one to two weeks to consider your request.

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