Important Insurance & Payment Update for 2027
Beginning February 1, 2027, Pediatric Eye Associates will be making changes to our insurance participation.
We will continue to participate in-network with Horizon/ Blue Cross Blue Shield. Other private insurance plans will be considered out-of-network.
We are sharing this information well in advance of the change date because many of our patients schedule their appointments months ahead.
Why is the practice making this change?
The traditional insurance model has become increasingly difficult for independent practices to sustain while providing the kind of personalized care we believe patients deserve. We’re making this change so we can continue practicing medicine in a way that supports that level of care. We know this is an important change for families, and we have not made the decision lightly.
When does this take effect?
The new policy begins February 1, 2027.
It applies to services provided on or after February 1, regardless of when the appointment was originally scheduled.
Which insurance will you accept?
We will continue to participate in-network with Horizon/ Blue Cross Blue Shield.
Other private insurance plans will be treated as out-of-network.
Can I still see you if my insurance is out-of-network?
Yes.
We would be honored to continue caring for your family.
You will pay for your visit at the time of service, and we will provide an itemized receipt that you can submit to your insurance company for any out-of-network benefits available under your plan.
In addition, we can also submit a claim to your out-of-network insurance as a courtesy. We cannot guarantee the level of reimbursement. Any benefits would be paid to the family.
Is there a discount for out-of-network patients?
Yes.
Patients paying out-of-network will receive a 20% discount from our standard fees.
How much does a visit cost?
Fees depend on the examination and services required.
New patient exam: $400 after the 20% out-of-network discount.
Established patient exam: $375 after the 20% out-of-network discount.
How will you help with out-of-network health insurance benefits?
For patients with Horizon/ Blue Cross Blue Shield as their primary health insurance, we will continue to submit claims directly to BCBS as an in-network provider.
For patients with other private health insurance plans, our practice will be considered out-of-network beginning February 1, 2027. Payment for the visit will be collected in full at the time of service. After payment is received, we will submit the claim to your health insurance company as a courtesy on your behalf.
Any reimbursement or benefit payment from your insurance company will be sent directly to the family. The amount of reimbursement will depend on your individual insurance plan and its out-of-network benefits.
We will also provide the family with a detailed, itemized receipt. You may use this receipt to submit a claim independently if you prefer, or to submit the visit to your vision insurance plan, if applicable.
Please keep in mind that:
- Out-of-network benefits vary by insurance plan.
- Your plan may have an out-of-network deductible or other requirements before benefits are paid.
- We cannot guarantee that your insurance company will reimburse you or how much it will pay.
- The insurance company determines the reimbursement amount and sends any payment directly to the family.
Why can’t you remain in-network with all insurance plans?
Insurance participation has a significant impact on how our practice operates and on the way we are able to provide care to our patients.
The traditional insurance model has become increasingly difficult for independent practices to sustain while providing the kind of personalized care we believe patients deserve. This change will allow us to maintain a practice focused on providing the time, attention, and personalized care that we believe are important for our patients and families.
We understand that insurance changes can be difficult for families, and we have not made this decision lightly. Our goal is to continue caring for our patients while creating a sustainable model for the practice moving forward.
I already have an appointment after February 1. What should I do?
You don’t need to cancel or reschedule simply because of this change.
If your insurance will be out-of-network beginning February 1, please review your plan’s out-of-network benefits and contact our office if you have questions about our fees or payment process. You can call our Billing Coordinator directly at (973) 422-1230 x 105.
We are notifying patients now because many appointments are scheduled six months or more in advance.
What if I need to stay in-network?
If your family’s insurance coverage makes an in-network provider necessary, we recommend contacting your insurance company directly and requesting a current list of participating pediatric ophthalmologists.
Your insurance company can provide the most accurate and up-to-date information about providers participating in your specific plan.
How can I request my child’s medical records?
If you decide to transfer your child’s care to another provider because of this insurance change, we are happy to provide a copy of your child’s medical records.
Please complete our Medical Records Request Form and email the completed form to [email protected].
Our standard records fee is $1 per page; however, we will waive the records fee for families requesting records in connection with this insurance change.
Once we receive the completed form, our team will process your request and provide the records as appropriate.
Are you accepting new patients?
Our ability to accept new patients depends on current appointment availability.
Demand for our care is currently very high, and there may be times when we are unable to accept new patients.
Please contact our office at (973) 422-1230 for the most current information.
We have been patients for years. Does this change apply to us?
Yes. The new insurance policy applies to services provided on or after February 1, 2027.
We deeply value the families who have trusted Dr. Bloom and our team over the years. We hope to continue caring for your family and providing the same thoughtful, personalized care you have come to know.
Why are you telling us so far in advance?
Because we respect your time and want you to have choices.
Our schedule is frequently booked months in advance. We don’t want anyone to be surprised by an insurance or payment change when they arrive for an appointment.
Giving families advance notice allows you to understand your insurance benefits, ask questions and decide what is right for your family.
What matters most to us?
Your child’s care.
Our team is deeply committed to our patients and families. This change is intended to help us build a sustainable practice so that we can continue providing exceptional pediatric eye care for years to come.
Thank you for your trust.