Clinical motivation for optical services

Some optical procedures and products have clear clinical benefits, while others depend on the member's particular health status and require clinical motivation.

In these instances, GEMS will request additional information (motivation) when the clinical circumstances are not obvious. Common requests for motivation relate to single vision surfaced lenses, multifocal lenses prior to presbyopia (when the eye shows a diminished ability to focus on near objects) and diagnostic procedures.

The clinical benefits of the procedure or product, which shows that further investigation is required, must be included in the motivation. Random or routine use of diagnostic procedures may not be seen as clinically essential.

Ensure that you understand what treatment you are receiving and what motivation is required by GEMS for easy access to your optical benefits.