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NJ EYE PROFESSIONALS
908-222-8700
Patient Resources
Everything you need to know
Insurance Participation
Medical Plans
Vision Plans
Payment Policy
Referrals and Pre-Authorizations
Insured Party
Premium
Co-Payment
Deductible
Vision Exam Versus Medical Eye Exam
Vision Wellness Exam or Medical Eye Exam
We welcome all patients regardless of insurance coverage! Please call us if you don't see your insurance carrier so we could check for you. Our friendly staff can provide an itemized receipt which can be used for insurance reimbursement. Since there are so many different health care plans available today, we encourage you to contact your plan provider directly for information regarding your unique coverage, benefits, and process for claim reimbursement. Most insurance companies have made the steps very easy and they can be a great resource for helping you file a quick and efficient claim. Please feel free to call us if you have any questions.
AETNA
UNITED HEALTH CARE
AMERIHEALTH
CIGNA
QUALCARE
MULTIPLAN
SUPERIOR VISION
DAVIS VISION
EYEMED
EYEQUEST
MARCH VISION
SPECTERA
NVA- NATIONAL VISION ADM
I.B.E.W. LOCAL 1158
Please have your insurance information available when making your appointment. If you do not have insurance, or your plan is not listed here – payment will be due in full on the date of service. For your convenience, we accept Visa, Master Card, checks, and cash.
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As a courtesy to our patients, we will file insurance claims for all insurance plans in which we participate. However, please keep in mind that you are ultimately responsible for payment. Any charges not covered by your insurance, are due and payable at time of service, or upon receipt of a statement from our office. Statements are mailed after insurance has processed your claim. Any reimbursement from your insurance carrier will be reflected on your statement. In addition, your insurance carrier will send an explanation of benefits that details how your claim was processed and paid.
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It is however the patient’s responsibility for any co-payments and deductible amounts or any non-covered services. Please note, any balance not covered by insurance is the patient’s responsibility.
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We’ve made paying your statement even easier with our online payment portal.
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Patients can now use our secure payment portal to make payments on their outstanding account balances. It’s fast and easy and super convenient.
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We accept all major credit cards: American Express, Discover, MasterCard, and Visa.
If your insurance company requires a referral and/or pre-authorization, you are responsible for making sure that the referral and/or pre-authorization is obtained. Failure to obtain it may result in non-payment or a significantly lower payment from the insurance company, and the remaining balance will be your responsibility.
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Please review your benefits with your plan administrator for detailed information regarding your coverage.
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We know insurance can be difficult to understand since some plans do not cover all services. To make it easier, we have provided some information on terminology used and answer to frequently asked questions.
The patient or member who has insurance coverage.
The cost of the insurance plan paid in regular intervals by the covered individual and sometimes his or her employer. Medical service providers have little interaction with this portion of the consumer’s financial responsibility.
​A specified amount of money that the patient must pay before an insurance company will contribute to the cost of care in accordance with plan guidelines.
The dollar amount that an insured party must pay toward a covered service at the time of care.
Insurance coverage for eye exams vary. Some plans only pay for routine, well visits. Other insurance plans will cover an exam only if a medical eye condition or disease is present. Knowing the reason for your visit will allow our staff to bill your insurance properly and ensure you are receiving the appropriate care.
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Some patients may have specific vision insurance to cover all or a part of this type of visit that is different from their medical insurance.
In order to better prepare for your visit we would like to provide an explanation of Medical vs Vision exams.
The type of exam the insurance company billed is dependent on the purpose of the exam.
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Which do you need?
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A vision exam focuses on refractive Errors of the Eyes, and is a superficial inspection of the Eye for other Diseases. The main purpose of a Routine Eye Exam is to produce a prescription for Eye glasses, if a Contact Lens Prescription is required, additional charges can apply depending on your Insurance Company. No extensive procedures to Diagnose, evaluate severity, document or treat Eye Disease will be performed in a Routine Eye Exam, only Eye Glasses or Contact Lens Prescription, no Therapeutic medicine prescription will be given in a Routine Eye Exam visit.
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A medical eye exam is defined by the need to diagnose a new medical condition or manage known medical condition that affects the eyes or optical pathways in the brain. A medical exam is typically covered by medical insurance and includes diagnosis and treatment of eye related medical diseases, such as glaucoma, macular degeneration, cataracts, corneal disease, eye infections, dry eye, pink eye, foreign body removal, headaches, and sometimes lazy eye, etc.
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If the intention for your visit is to be evaluated for a medical eye condition, then notify the appointment scheduler that you need a medical eye exam. We will expect to bill your medical insurance for this exam. If your insurance requires a referral, please contact them to ensure one is on record before your appointment, unless you prefer to pay out in full on the day of service.
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If at a vision wellness exam, the doctor suspects an eye disease is present, it is likely that you would be scheduled to return for a medical eye exam, utilizing your major medical insurance.
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We advise you call your insurance company to verify benefits and coverage if you are unsure if you have both vision and medical coverage. Your insurance company is the best source to answer questions about your coverage. However, please keep in mind that the representative may not know your particular case. Please ask if the refraction code of “92015” is covered. Many times if you have both vision and medical insurance they are through two separate insurance companies so be sure to check for multiple sources of coverage, or contact your human resources department for help.
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If you have multiple eye issues please discuss your case with us as not all conditions can be addressed at the same date of service.