Your patients show up for their injections.

Parlor makes sure your anti-VEGF patients have everything they need for their appointment, starting with a ride and a person to come with them. You refer. Everything after that is ours, including the initiating visit Medicare requires and the claim that follows it. Your practice does not bill for this and does not chart for it.

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A no-show in retina is not a rescheduling problem.

Every other specialty can move an appointment. You cannot move the interval. A patient extended to eight weeks who is seen at twenty has not been rescheduled. He has been untreated for three months, and the OCT on the day he comes back tells you what it cost.

Obeid and colleagues followed 9,007 patients receiving anti-VEGF for wet AMD at one urban retina practice. 2,003 of them went twelve months or more with no follow-up visit. Those patients averaged 7.8 injections over 1.2 years. The patients who stayed averaged 14.3 over 2.4 years.

22.2%

of 9,007 wet AMD patients on anti-VEGF had a gap of twelve months or more with no follow-up.

Obeid et al., JAMA Ophthalmology, 2018

82%

of US patients on intravitreal injections said they relied on a caregiver or public transportation to reach their appointments.

Robinson et al., Clinical Ophthalmology, 2025

65.9%

of returning DME patients whose vision had dropped during a gap still had not recovered it after treatment resumed.

Zhou et al., Ophthalmology Science, 2026

Soares and colleagues at Wills Eye looked at 93 wet AMD eyes that came back after a mean of 346 days away. Central foveal thickness responded once injections resumed. Visual acuity did not, and was still down at final follow-up. The fluid comes back out. The letters do not come back.

The disease is the barrier

The appointment they cannot reach is the one holding the sight they would need to reach it

Central vision is what driving takes. In a 2025 survey of 101 patients on intravitreal injections and 100 ophthalmologists, 82 percent of patients said they depended on a caregiver, public transportation, or both to get to treatment. Patients aren’t being careless. Most are in their eighties, treated for a disease of the macula, and dilated before they go home.

Which means the failure point sits outside the clinic and outside medicine. Somebody has to drive. In most specialties that is a logistics detail. Here it is the mechanism of the disease closing the only door to the treatment.

Your risk model is already a map of geography and age

In the Obeid cohort the odds of loss to follow-up rose with distance from the clinic, 1.33 times at 21 to 30 miles and 1.55 times beyond 30, and with age, 3.31 times past 90. The IRIS Registry, 156,327 treatment-naive wet AMD patients, found the same shape, and added Medicaid coverage and unilateral disease.

Unilateral is the one worth sitting with. A patient who still sees well on the other side feels finished, and disappears at higher odds than the patient with worse vision in both eyes. The better the good eye, the weaker the reason to make the trip.

The field is probably ranking these barriers in the wrong order

In that same survey, the ophthalmologists rated the same burdens their patients rated. 62 percent named insurance as the greatest barrier in their practice, and they scored insurance as harder on patients than the patients scored it. Transportation ran the other way. Patients rated it harder than their clinicians believed, and the difference was significant.

So the barrier the field is most confident about is being overestimated, and the barrier nobody is staffed for is being underestimated. Insurance at least has a person assigned to it in most practices. The ride does not.

The most common reason given is not ophthalmic at all

Of 100 patients who missed an anti-VEGF appointment at a tertiary eye center, the reason given most often was a competing illness, 39 percent, followed by administrative problems such as an unreturned coverage form, 28 percent. 73 percent of them needed someone to accompany them.

None of that gets worked by the person making the recall call, because none of it is in the chart and none of it is theirs to fix. It is somebody else's hour.

Sources: JAMA Ophthalmology 2018, Ophthalmology 2023 (IRIS Registry), Clinical Ophthalmology 2025, Ophthalmic Research 2025.

What we do before treatment day

01On referral
You send the patient. A Parlor clinician furnishes the initiating visit that Medicare requires before navigation can begin, and consent and the coinsurance disclosure are handled in the same week.
02Between injections
Contact runs on a cadence set by the injection interval. The questions are the ones that decide whether treatment day happens. Who is driving, and who is walking in with them.
03When it breaks
A ride that falls through gets worked, not logged. So does a coverage form sitting unreturned at the plan, and a caregiver whose shift changed in March. If the date has to move, we move it with your scheduler before it becomes a gap.
04Back to you
Your office gets the appointment confirmed and a note when something we found should reach you, such as a patient who has decided she is finished. We do not read imaging and we do not discuss the interval.

Your team stops chasing

The calls your staff make to fill a cancelled slot, the voicemails nobody returns, the patient who has been extended and quietly decided they are done. We take all of it. Your schedulers go back to scheduling.

Between visits, one navigator holds each patient. They confirm the ride before the day, find out who is bringing them, and call when a driver falls through rather than after the chair sits empty. When something needs you, it arrives with the history attached instead of as a message slip.

You refer. Nothing else lands on your practice. We are a Medicare practice and we bill for the navigation ourselves, so your team does not bill for it, chart for it, or supervise anyone, and your injection, imaging, and visit claims are untouched.

Ask about a referral list

Open a file

Four things that happened between injections. What arrived, what we did, and what the clinic got back. Examples, with patients de-identified.

Wet AMDCHI

Two missed injections, and the chart said no-show twice

What arrived: He was on a six-week interval and had gone eleven weeks. The record held two no-shows and nothing else. The check-in before the third appointment asked how he was getting there. The county senior van books eight days out, his daughter had been driving him instead, and she had started a job with Saturday shifts.
What Parlor did: Transport was recorded as the upstream driver rather than the behavior. The van was booked first and the appointment was set against it, which is the opposite of how it had been done, and the next two were booked the same way.
What the clinic got: A confirmed arrival, and one line for the scheduler: this patient's appointments need to be made at least eight days out.

He has not missed one since. The barrier was a booking window, and nobody had asked.

Questions from retina practices

Does this change anything we bill?

No. Your injection, imaging, and visit claims are unaffected. PIN and CHI go out under our NPI. The one rule to know is that for a given patient, only one practitioner may bill each of these services in a calendar month, and for your referrals that practitioner is us.

What do you tell the patient about their eye?

Nothing. We do not interpret imaging, discuss the interval, comment on the agent, or answer questions about the retina. Those go back to your team the same day they are asked. We work the reasons treatment day does not happen.

Our patients are already on a recall list. How is this different?

A recall list tells a patient when to come. It does not find out why they did not, and it cannot act on the answer. The difference is not the reminder. It is an hour a month spent on the ride and the coverage form and the person who has to walk in with them, and somebody whose only job that is.

Who does the initiating visit?

A Parlor clinician. It is separate from anything in your clinic, and Medicare requires it before navigation can be billed, because the practitioner who furnishes the initiating visit has to be the one who furnishes and bills the navigation that follows. We arrange it with the patient directly.

What does it cost the patient?

Twenty percent coinsurance on what is billed, which is roughly $17 in a month where only the PIN base code is billed. Secondary coverage generally absorbs it. These are not preventive services, so the coinsurance cannot be waived, and it is disclosed before consent rather than after.

Has anyone run this in retina before?

Not that we can find. PIN and CHI took effect in January 2024 and the published guidance and worked examples come from oncology, primary care, and behavioral health. We have found no retina or ophthalmology program described in the literature or in the coding guidance. We would rather tell you that than imply a precedent that does not exist.

What happens when a patient stops answering?

We keep the schedule of attempts and we tell you when someone has gone quiet, which in retina is the signal that matters. The IRIS Registry defined loss to follow-up as no documented encounter within twelve months of the last injection. By twelve months the letters are already gone. We raise it at the second missed contact.

Send us one month of missed injection appointments. We will tell you what was actually in the way.

Take the last thirty days of no-shows and cancellations from one clinic. We will come back with which of them meet the PIN or CHI gate, and what the contact would have looked like before the next one.

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