INSURANCE
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.
Some of the VISION PLANS we participate in are:
- Vision Service Plan (VSP)
- Eyemed (We participate in many Eyemed plans but not all of them. Please check with the office
to make sure we participate in your specific Eyemed plan)
- Humana Vision Plan
Some of the MEDICAL INSURANCE PLANS we participate in are:
- Medicare
- Horizon
- Blue Cross Blue Shield
of NJ
- Aetna
- Anthem Health
- Beechstreet
- Cigna
- Health Net
- Multiplan
- Oxford
- PHCS
- Qualcare
- RR Medicare
- Travelers
- United Health Care
- VSP- Primary
Eyecare
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:
Vision Care Plans
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.
Medical Insurance Coverage
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.
Vision Insurance vs. Regular Health Insurance
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.
Insurance CHECKLIST
1) What is the primary reason for you visit?
- Is it VISION related (glasses or contact lenses) which may be covered under a vision Plan?
- Is it a MEDICAL eye condition which may be covered under your medical insurance?
2) Do we participate in your insurance or vision plan? (see list below)
- If we participate, we will submit all forms and paperwork and we’ll receive payment directly
from the insurance company
- If we do not participate, we will provide you all the necessary paperwork that you’ll need to apply
yourself for direct reimbursement from your insurance company.
3) Do you need pre-authorization?
4) Are you currently eligible to receive benefits
- Some vision plans only allow routine vision exams every calendar year or every 12 or 24 months.
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.
Privately Administered Eyecare Plans
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.
