Policyholder Services

Does OMIC cover remote ROP screening?

As evidenced by the widely publicized (non-OMIC) Florida verdict in 2008 for $38 million, which followed several other multimillion dollar verdicts over the prior decade, ROP claims have the potential for extremely high damages. To protect the financial interests of the company and its owner insureds from such claims, OMIC has adopted a conservative approach to underwriting ROP coverage. Each physician who screens for or treats ROP must complete a supplemental ROP questionnaire (download above), which is reviewed by members of OMIC’s physician review panel.

Coverage extends to qualified ophthalmologists who provide ROP services when they use binocular indirect ophthalmoscopy (BIO) for each exam to determine an infant’s ROP status. Ophthalmologists who provide care at hospitals with retinal cameras may use the cameras as part of their documentation of the ROP exam. Coverage also applies to insureds who provide second opinions by reviewing retinal photographs taken in conjunction with another ophthalmologist’s BIO exam. However, the policy specifically excludes coverage for “remote screening,” a type of telemedicine that uses remote digital fundus imaging (RDFI-TM) instead of a BIO exam to evaluate an infant’s ROP status.

Coverage for “remote screening” is available only by special endorsement and is subject to underwriting review and approval of both the general ROP questionnaire and a separate questionnaire applicable to remote screening. Physicians who at times use photos instead of a live exam must apply for coverage of remote screening. To qualify for coverage, the physician must also comply with OMIC’s underwriting requirements specific to remote ROP screening as well as the company’s standard underwriting requirements for ROP.

Updated 5/30/2018