TearCare Promise

Find the Claim Form Here

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Program Terms and Conditions
To participate in the TearCare® Promise program, patients must meet the below clinical requirements and consent to the retreatment plan. Full reimbursement shall constitute the cost of the procedure to the patient minus any prior patient rebates up to $1500. A copy of the bill noting the TearCare® procedure and cost of procedure is required to process any claims.

TBUT and SPEED scores are the ONLY sign and symptom measures recognized as valid measurements in the TearCare® Promise Program. Prior to first treatment, a patient’s baseline signs (TBUT) and symptoms (SPEED score) must be noted in the medical record. Both TBUT and SPEED score must be captured.

Post initial TearCare evaluation (retreatment claim):
If 4-6 weeks after a patient’s initial TearCare® procedure the TBUT has not improved by 50%, AND SPEED score has not improved by 50%, Sight Sciences will provide the patient (via their prescribing ECP) free-of-charge a set of SmartLids™ for a second treatment if the patient so chooses to be retreated.

Post Retreatment Evaluation (reimbursement claim):
If 4-6 weeks after the second treatment the patient’s TBUT has not improved by 50% over original baseline, AND SPEED score has not improved by 50% over original baseline, Sight Sciences will reimburse the patient’s TearCare procedure cost, excluding any prior rebates paid or other visitation fees that may be charged by the practice or facility. The patient will need to provide evidence of the cost of the TearCare® procedure (up to $1500).

The TearCare® Promise Program is only available to patient-pay patients, i.e., those not seeking reimbursement for the value received from this treatment from either commercial or government payors. By submitting this TearCare® Promise claim form, you are confirming that you are not a federal health care program beneficiary or eligible for Medicaid (including Medicaid managed care), Medicare (including Medicare gap or Medicare Advantage), TRICARE, Veterans Affairs, or similar state or federal programs. The TearCare® Promise program is prohibited for minors, and is void where prohibited by law, or otherwise restricted.

Your rights to this program cannot be assigned or transferred and this program is void where restricted or prohibited by law. Excessive submissions constitute fraud and may result in federal prosecution under the US mail fraud statutes (Title 18, USC 1341 and 1342). All submitted materials become TearCare® property and will not be returned.

Privacy: Your contact information may be used by Sight Sciences for market research and marketing purposes. Not applicable to California residents unless they have opted into this program. None of the information provided will be shared with third parties. Your contact information will be protected by Sight Sciences’ privacy policy. For information on Sight Sciences’ Privacy Policy go to: https://www.sightsciences.com/privacy-policy

Sight Sciences, Inc. reserves the right to rescind, revoke or amend this TearCare® Promise program without notice.

Call 1-888-580-8286 weekdays, 8am to 5pm CT if you do not receive notification of claim status within 30 days of the postmark date on your TearCare Promise claim.

You can click here to download a copy of the form.

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