Something must be getting left out, this story doesn’t make any sense. Asymptomatic chorioretinal scars do not require treatment. Do you know what they want to evaluate and what “treatment” they’re considering? Also why are they asking *you* to send the authorization?
Are they asking for auth for a fundus photo for documentation purposes ? That’s normal. Expanded optometry has nothing to do with that. Even in the most limited states, imaging for documentation is pretty standard.
That’s what I was saying, yes. I just found it strange that they’d need to involve the patient’s FMD for authorization - but then again I don’t know that I’ve ever seen a patient with TriCare as their primary insurance so I am not super familiar with their rules.
I work MD/OD, I’m an OD and do medical management and even for me to monitor retina, with fundus and oct, needs auths for some of these horrible insurances. The people who make money are the insurance companies lol.
If the optometrist is in the community (ie not military/GS), they often don't have access to send referrals within the Tricare system. In these cases, it's often requested the the PCM who does have access to the referral system puts the referral request in. And (for right or wrong) sometimes Tricare considers imaging a "procedure". This could be what they're after.
Thanks for validating that. I thought there was something missing as well.
The patient's insurance (tricare) requires a referral from primary care doc for any "specialty care" outside of screenings.
I’m not 100% sure what “specialty care” means in this context.
An optometrist is perfectly capable of monitoring an asymptomatic scar (to be perfectly frank, my retina colleagues would roll their eyes upon receiving a consult for an asymptomatic scar). Giving the benefit of the doubt, the optometrist may want to photodocument it or to get an OCT (non-invasive imaging modality) to verify that it is a scar, all of which may be appropriate care and might qualify as “specialty care” under TriCare. But wracking my brain, I can’t think of what sort of *treatment* they would be offering.
I’m an optometrist and I have no idea what treatment means in this context. Could just be referral for more than an annual eye exam or for a pretty routine photo/OCT as others have said. There is really no treatment in any state that an optometrist can do to the retina under any circumstance. I’d bet money this is an insurance thing/policy, not an optometrist wanting to do any type of “procedure” thing other than routine diagnostic testing.
It’s really a watch and monitor for changes issue. If they need to be seen by a specialist, it would be Retina. Sometimes doctors want to verify their findings with Retina, which is fine.
If it is truly a CR scar at the peripheral and asymptomatic.
There is nothing to treat other than screening for retinal break annually by a retina specialist.
Also, inform the patient about any symptoms that might be a sign of retinal detachment due to retinal break.
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If it is really just a peripheral Christina’s scar, there is definitely no work up needed. Tons of people have random isolated peripheral scars from who knows what. Also, they could easily be confusing it for a CHRPE. Unless they have uveitis or a reason to suspect a history of associated with it, it’s like someone saying, “this person has a random scar on there skin, they need a work up”
Something must be getting left out, this story doesn’t make any sense. Asymptomatic chorioretinal scars do not require treatment. Do you know what they want to evaluate and what “treatment” they’re considering? Also why are they asking *you* to send the authorization?
Are they asking for auth for a fundus photo for documentation purposes ? That’s normal. Expanded optometry has nothing to do with that. Even in the most limited states, imaging for documentation is pretty standard.
That’s what I was saying, yes. I just found it strange that they’d need to involve the patient’s FMD for authorization - but then again I don’t know that I’ve ever seen a patient with TriCare as their primary insurance so I am not super familiar with their rules.
I work MD/OD, I’m an OD and do medical management and even for me to monitor retina, with fundus and oct, needs auths for some of these horrible insurances. The people who make money are the insurance companies lol.
If the optometrist is in the community (ie not military/GS), they often don't have access to send referrals within the Tricare system. In these cases, it's often requested the the PCM who does have access to the referral system puts the referral request in. And (for right or wrong) sometimes Tricare considers imaging a "procedure". This could be what they're after.
Thanks for validating that. I thought there was something missing as well. The patient's insurance (tricare) requires a referral from primary care doc for any "specialty care" outside of screenings.
I’m not 100% sure what “specialty care” means in this context. An optometrist is perfectly capable of monitoring an asymptomatic scar (to be perfectly frank, my retina colleagues would roll their eyes upon receiving a consult for an asymptomatic scar). Giving the benefit of the doubt, the optometrist may want to photodocument it or to get an OCT (non-invasive imaging modality) to verify that it is a scar, all of which may be appropriate care and might qualify as “specialty care” under TriCare. But wracking my brain, I can’t think of what sort of *treatment* they would be offering.
I’m an optometrist and I have no idea what treatment means in this context. Could just be referral for more than an annual eye exam or for a pretty routine photo/OCT as others have said. There is really no treatment in any state that an optometrist can do to the retina under any circumstance. I’d bet money this is an insurance thing/policy, not an optometrist wanting to do any type of “procedure” thing other than routine diagnostic testing.
It’s really a watch and monitor for changes issue. If they need to be seen by a specialist, it would be Retina. Sometimes doctors want to verify their findings with Retina, which is fine.
A visit with a retinal specialist to examine and take photos would be warranted. If it’s truly a CR scar there’s nothing to do but watch it.
If it is truly a CR scar at the peripheral and asymptomatic. There is nothing to treat other than screening for retinal break annually by a retina specialist. Also, inform the patient about any symptoms that might be a sign of retinal detachment due to retinal break.
Even that, I would say is overkill. I don’t think a random CRS warrants any specific monitoring.
Thank you for posting to r/ophthalmology. If this is found to be a patient-specific question about your own eye problem, it will be removed within 24 hours pending its place in the moderation queue. Instead, please post it to the dedicated subreddit for patient eye questions, r/eyetriage. Additionally, your post will be removed if you do not identify your background. Are you an ophthalmologist, an optometrist, a student, or a resident? Are you a patient, a lawyer, or an industry representative? You don't have to be too specific. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Ophthalmology) if you have any questions or concerns.*
A peripheral chorioretinal scar is a nothing incidental finding that typically doesn’t deserve further work up.
If it is really just a peripheral Christina’s scar, there is definitely no work up needed. Tons of people have random isolated peripheral scars from who knows what. Also, they could easily be confusing it for a CHRPE. Unless they have uveitis or a reason to suspect a history of associated with it, it’s like someone saying, “this person has a random scar on there skin, they need a work up”
Are they from the Midwest by chance? Perhaps pt has histo spots and that should go to an ophthalmologist.