Frequently Asked Questions
Do you take my insurance?
For a full list of the insurance we currently take please visit the patient center page.
We take most vision plans. The common vision plans that we do not accept are VSP and Davis Vision.
We take most of the common medical plans in the Somerset area and are working on getting on more plans. However, medical insurance is complex and there may be some PPO and HMO plans within insurance companies that the doctor is considered out of network for. Dr. Theroux’s NPI (national provider identifier) number is 1023627031. This is the number to provide to your insurance company when looking up or calling to see whether she is an in-network provider.
What is your policy on…. being late/ glasses remakes/ measuring PD etc.?
Please refer to our patient center page for our current policies.
What ages do you see for exams?
We do not have any age restrictions on eye exams. Generally eye exams can start at 6 months old and Dr. Theroux is very equipped to see infants and young children. See our pediatric exams page for more information.
We do not have an upper age limit either. Do let us know if you need any accommodations or longer exam times for yourself or someone you care for in advance so we can help to our utmost ability. We can do a wheelchair accessible exam for those who cannot transfer to the exam chair. We also have large print versions of paperwork available.
How much is an eye exam?
The typical eye exam in our office without insurance will average $85 – $200 dollars. It is difficult to give an exact number in advance as the final cost depends on whether medical concerns are being addressed and if there are screening photos, special testing that needs ordered, or a contact lens fitting. We try to be as transparent as possible during your appointment as to what your final total will look like so you can make decisions on splitting visits up when necessary.
How much is a contact lens fitting?
A contact lens fitting (outside of insurance benefits) is $50 for an established wearer and $65 for a new wearer. The main reason for the difference in cost is that new wearers require extra time for insertion & removal training, education on wearing contact lenses, and sometimes more follow ups and trial lenses. See our contact lens page for more information and FAQs on contact lenses.
How much are glasses?
We have basic self pay glasses options starting at $100 for single vision or lined bifocal glasses. If you are on medicaid, we aim to have at least a basic option that will be covered by your plan. Beyond that, prices will vary greatly depending on frame choice, add ons, and insurance coverage. We are happy to work up a quote for you even if you are not ready to purchase. We also take care credit and offer 6 months deferred interest on purchases $200 or more using care credit. We require 50% down on all orders.
You can find more information on our promotions and glasses brands on our optical page.
How do I get my driver’s form/school form/work form filled out?
If you have an appointment coming up, simply bring your form with you to the appointment and make sure to let the doctor know about it to ensure they do all the necessary tests.
If you have had an eye exam within 6 months, we can likely fill your form out based on that if you bring it to the office. You may have to drop it off until the doctor has time to fill it out for you. If it has been longer since you had an exam or there are certain tests required on the form that were not performed we will make a recommendation for either a short follow up visit or a new comprehensive exam.
Why did you bill my medical insurance when I have a free eye exam or lower copay under my vision insurance?
Refer to this helpful guide on the difference between vision exams and medical exams.
Medically focused exams require more time and complexity as well as more liability for the doctor. For this reason, it is inappropriate to bill these as routine “screening” exams and this also does not properly compensate the doctor for their time and knowledge. Most of the same testing will be performed between both exams which can make it seem confusing that there is a difference. The deciding factors are usually what the chief reason for the visit is and what the main diagnosis codes for the visit end up being. Typically, if the main reason and main diagnosis for the exam come down to needing glasses or contact lenses, that is a routine exam. If the main diagnosis or reason is medical in nature (such as diabetes, cataracts, dry eye, etc.), the exam must be billed medically.
Why did I get a bill in the mail?
Up front costs such as copays and self pay exams will be collected at time of service. If you are receiving a bill after your visit, the most likely reason is that your insurance claim has been processed and your insurance company has specified part of the cost as “patient responsibility”. Usually this is due to a deductible. Sometimes, it is due to coinsurance or a copay that was not collected at the time of service. There are also times where insurance companies require prior authorization or certain qualifiers to be met for a service or exam to be covered and you will be responsible for charges that are not considered “covered” by your insurance. We try our best to include description or documentation of why the charges are owed but you can always contact us or your insurance company with questions.
What is a refraction and why didn’t my insurance cover it?
A refraction is the professional term for the service where the doctor checks your best-corrected vision (the “1 or 2” test). The CPT or procedure code for insurance purposes is 92015. Routine vision exams include the refraction service as part of the procedure code (S0620 or S0621). Comprehensive medical eye exam codes (92 codes) and medical office visit codes (99 codes) do not include refraction so therefore it is added as a separate service code when it is performed in conjunction with a medical visit. Some medical insurance plans will cover this code or allow it to go towards a deductible, but some consider it a non-covered code. Medicare does not cover the refraction code. Some supplement plans will cover it after Medicare denies it, but not all.
Refraction is still very important to addressing underlying medical issues (and is necessary to obtain a glasses prescription) so it is typically still performed at all comprehensive exams and therefore must be billed for too so we can stay compliant with medical coding guidelines and the doctor can be reimbursed for their work accurately. A refraction at our office is charged at $35 dollars. If you would like to pay the refraction out of pocket instead of us billing your insurance we will apply a prompt pay discount that brings it to $28. This is recommended for Medicare patients who have no supplement as Medicare will always deny the code and it will only save you money to pay up front rather than having us bill Medicare.
When you get a contact lens fitting, we consider the refraction to be included in that service and you will only be billed the fitting in that case. Medical insurance plans do not cover contact lens fittings, but we can bill this separately to a vision insurance plan if you have one that we accept.
Most vision plans do not allow us to bill only the refraction separate from a routine eye exam, but if your plan offers this we are happy to coordinate your benefits to reduce your out of pocket cost.