INSURANCE FAQs
When booking an appointment at our office, we will make every effort to educate you about your insurance plan coverage options; however, it is ultimately the responsibility of the patient/parent to know his/her benefits.
Please be advised, our pediatric ophthalmologists will ALWAYS bill a medical exam and NEVER a routine eye exam. As a result, your claim will be sent to your major medical insurance, and processed as a medical office visit that may be subject to a copayment, coinsurance charge, and/or deductible. Please contact your carrier for specific coverage and benefit details.
Do you participate with my insurance?
Our office participates with all major insurance plans and will make every effort to work with you if you do not see your plan listed below. Please check with your carrier for the most up-to-date participation information.
Aetna
Amerihealth
Consumer Health Network (CHN)
Cigna/Great West
Emblem Health (QualCare Network ONLY)
Empire
First Health
Horizon Blue Cross/Blue Shield
Humana Military/USFHP
Local Carriers (Call for Specific Plan)
Magnacare/Health Care Payors Coalition (HCPC)
Medicaid
Medicare - Dr. Rousta and Dr. Sun ONLY
Multiplan
NJ Family Care Plans - OPHTHALMOLOGISTS ONLY
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Amerigroup
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Horizon NJ Health
Oxford
PHCS
QualCare
United HealthCare
Do you participate with my Vision Care Plan (e.g., VSP, Davis Vision, MetLife)?
No. UCEC does not participate with ANY separate vision care plans. You are welcome to book an appointment as a self-pay patient and we will provide you with an itemized receipt that you may submit to your carrier for potential reimbursement.
Do I need a referral?
If you have an HMO, or if your card indicates that a referral is required to see a specialist, then you MUST OBTAIN A REFERRAL. Typically, patients with the following carriers require a referral:
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Aetna HMO
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Amerihealth HMO
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Horizon HMO
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Horizon NJ Health
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Oxford HMO
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United HealthCare Compass
If you do not see your plan listed, it does not mean that a referral is not required - you must check with your carrier for specific requirements. Please note that patients who are required to have a referral will NOT be seen if the referral is not received at their scheduled appointment time.
Are contact lenses covered by my insurance plan?
All contact lenses and contact lens related services are considered self-pay at UCEC. If you have coverage, our office can provide you with a detailed, itemized receipt for services and lenses for possible reimbursement by your carrier.
I have a question about a bill I received. With whom can I speak?
Our billing department can be reached by calling our Main Office at 732/613-9191 and selecting option 4, or dialing extension 712 directly. If you'd like to pay your bill online, you may do so by clicking here.