Policyholder Services

Does OMIC require that cataract surgery be performed only in an accredited facility?

Updated 11/4/2019

Due to concerns regarding the risk of endophthalmitis or other serious, vision-threatening complications associated with intraocular surgery and the difficulties the company would likely experience defending a resulting claim if intraocular surgery procedures were performed in a setting that did not meet existing standards for sterile conditions, OMIC would be reluctant to insure an outpatient surgical facility (OSF) in which cataract surgeries were performed if such facility were neither accredited by one the several national accreditation organizations nor Medicare certified.

While OMIC has implemented underwriting guidelines for coverage of OSFs, the company has not established requirements regarding therapeutic procedures such as cataract surgery performed by insured ophthalmologists.  There are no policy exclusions or underwriting requirements that prohibit performance of cataract surgery in a non-certified, non-accredited facility.  However, from a risk management perspective, we encourage insureds to perform intraocular surgery only in appropriate, approved settings.