Policyholder Services

I would like to perform sublingual immunotherapy (SLIT) to treat ocular allergies. Is this covered under my policy?

Subject to other policy provisions, OMIC will extend coverage to ophthalmologists for direct patient treatment they provide that is within the ordinary and customary scope of practice of an ophthalmologist. Until recent years, allergy testing and treatment of the underlying cause of the allergy were more traditionally performed by allergists. Because these activities did not fall within the ordinary and customary scope of practice of an ophthalmologist, coverage  previously extended under OMIC’s policy to ophthalmologists only for their diagnosis and treatment of ocular conditions caused by allergies (such as allergic conjunctivitis). Coverage for the diagnosis and treatment of the allergy itself applied only if specifically added by endorsement. Percutaneous skin scratch testing for ocular allergies and their treatment with sublingual immunotherapy has become more widely adopted by the ophthalmic community, however, and now falls within the ordinary and customary scope of practice of ophthalmologists. As a result, coverage under OMIC’s policy has automatically extended since 2015 to any ophthalmologist classified as Surgery Class 1 or higher. Please note that coverage for the treatment of ocular allergies is limited to sublingual immunotherapy. Coverage is not currently available from OMIC for treatment by injection.

Although rare, allergy skin tests can produce severe, life-threatening allergic reactions. Therefore, physicians who conduct allergy skin testing must ensure the practice has the proper protocols and equipment in place to respond promptly and appropriately to such emergencies.  The physician and/or office staff should be certified in Basic Life Support for Healthcare Providers or Advanced Cardiac Life Support (ACLS certification preferred). At least one such certified provider should be on the premises at all times when allergy skin testing is conducted. In addition, the practice should have a written emergency protocol in place and an emergency kit appropriately equipped with epinephrine, oxygen, and an ambu bag so that an airway can be established if needed and the patient can be stabilized while waiting for paramedics to arrive.  OMIC also recommends that offices be equipped with an automated external defibrillator (AED).

Updated 5/15/2018