Insurance Company Policies on Referrals and Vision Care

University Children’s Eye Center participates in many insurance plans, including HMO, POS, and PPO plans. Most plans require that you obtain authorization from your primary care physician (PCP) before specialist visits are covered. Be sure to bring your insurance card, co-payment, and the appropriate referral form or authorization number to your appointment.

Please click on your insurance company to the right for more information.

This list is given for informational purposes only. Insurance companies may change these requirements at any time. Contact your insurance company for the details governing your health insurance contract requirements and coverage.

Please note that a referral by your PCP does not ensure that a given service is a covered benefit. A referral is only an authorization from your PCP. For example, if your plan does not cover routine eye exams, the referral cannot be used.

Will my insurer pay for my child's routine eye exam?

- Although our doctors do a comprehensive ophthalmic exam on all new patients, many insurance policies do not cover eye exams for refractive error only.

- If the patient has myopia, astigmatism or other refractive error diagnosis, insurers pay for the comprehensive eye exam ONLY IF your plan has vision care coverage.

- In the majority of cases, routine eye exams are on a self-pay basis only.

- Sometimes employers purchase vision care benefits through vision care networks such as Davis, Metropolitan, VSP, etc. UCEC does not participate with any vision care network.

- Please refer to the insurance list for more details or contact your insurer.

Insurance List

Aetna/USHC

Referrals HMO and POS patients require referrals. Referrals are valid for one year, but the first visit must be used within 90 days.

Routine vision care Check with carrier. Referral required to come to our office.

AmeriChoice

Referrals A handwritten referral from a PCP (script) is required.

Routine vision care Not covered at UCEC. Must use vision care network or self-pay at UCEC.

AmeriHealth

Referrals None required.

Routine vision care Check with carrier.

CIGNA

Referrals None required.
Routine vision care Check with carrier. Most if not all patients have VSP (with which we do not participate).

Empire

Referrals HMO plans require referrals, which are valid for 90 days and must be made out to the doctor you are seeing.

Routine vision care Check with carrier. Self-pay in the majority of cases.

First Health

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Guardian

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

HealthCare Payers

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

HealthNet

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Health Network America (HNA)

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Horizon BCBS

Referrals Required for HMO, NJPlus, and POS plans. Referrals are valid for 180 days.

Routine vison care: Horizon HMO and NJPlus patients are entitled to one exam per year without a referral. Horizon Federal Employee patients do not have routine vision coverage. For most other Horizon plans, vision care is self-pay. Check with your carrier.

Horizon NJ Health (Formerly Horizon Mercy)

Referrals Required for all services. Referrals are valid for up to 180 days.

Routine vision care Not covered at UCEC. Must use vision care network or self-pay at UCEC.

Mastercare

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Magnacare

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Medicaid (SSI)

Referrals No referral required.

Routine vision care Check with our office.

Medicare

Referrals No referral required.

Routine vision care Not applicable. In our office we only see adults with strabismus or diplopia.

Medichoice

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Multiplan

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

One Health

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

Oxford

Referrals Required for HMO plans. Referrals are valid for 6 months. They must be made out to the doctor you are seeing. If you have the PPO plan, a referral is not required.

Routine vision care Self pay in the majority of cases. Check with carrier.

PHCS

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

QualCare

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

United HealthCare

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.

US Family Health Plan/TRICARE

Referrals No referral required.

Routine vision care Self pay in the majority of cases. Check with carrier.