We are dedicated to work with you to help you get the most value from your insurance and vision plans.
There are two general types of insurance coverage related to eyecare: vision care plans and medical eye coverage provided through medical insurance plans.
We also accept other plans as well, so if you do not see your plan listed here, please give us a call and we
would be happy to assist you.
Our staff is also always available to answer any questions regarding your benefits.
Read more about the difference between Vision Care Plans and Medical Insurance Coverage:
If your plan offers vision care coverage you may be eligible for a routine eye exam either yearly or every two years. Most plans also provide some form of benefit for glasses or contact lenses. You do not need to have a medical diagnosis from a Sparta or Newtown eye doctor, or any eye doctor, to use this type of coverage. Examinations of vision related conditions such as nearsightedness, farsightedness, astigmatism and focusing problems are usually covered under these plans.
Your exam, office visits and treatment may be covered if you have an appropriate medical diagnosis that affects the eyes, either directly or indirectly. Conditions such as glaucoma, cataracts, diabetes and high blood pressure fall into this category. In addition, certain symptoms such as headache, floaters and light sensitivity usually qualify as reasons for a medically necessary eye examination. Office visits for acute conditions such as conjunctivitis (pink eye), eye infections, eye injuries, eye inflammations or foreign bodies in the eye may also be covered under your medical insurance. As with all medical insurance, in order to receive your benefits you must meet the usual requirements for deductibles, co-payments and referrals as outlined in your specific insurance plan. It is always a good idea to check with your employer or insurance plan to determine the details of the coverage. If you have any questions regarding insurance and your eyecare, please feel free to give our office a call.
A vision insurance policy is not the same as health insurance. Regular health insurance plans protect you
against financial losses due to unexpected eye injuries or disease. Vision insurance, on the other hand, is a
wellness benefit designed to provide routine eye care, prescription eyewear and other vision-related
services at a reduced cost.
Eyecare services, glasses and contact lenses at our offices may be covered under your vision or medical insurance plans. Insurance and vision plan coverage and requirements can be complicated and confusing. It is always a good idea to check with your insurance plan or your employer to determine the details of your coverage. If you have any questions regarding insurance and your eyecare, please feel free to give us a call.
1) What is the primary reason for you visit?
2) Do we participate in your insurance or vision plan? (see list below)
3) Do you need pre-authorization?
4) Are you currently eligible to receive benefits
5) Do you know if you have any deductibles and co-insurance amounts?
6) Do you need a referral from your Primary Care Physician (PCP)?
Please be sure to call our office if you have any specific questions about our participation in a vision or medical plan.
We work with local companies to offer private plans for their employees. We customize each plan to meet the specific needs of the company and its employees. Some companies cover their employees either partially or fully for eyecare services, while other companies participate in a plan that provides their employees and their dependents with the opportunity to receive our services and materials at a reduced cost. If your company would like to learn more about our privately administered eyecare plans, we would be happy to provide you with an information packet. Please call our business office at 973.726.0669 if you would like more information about setting up a private vision plan for your company.