If you saw an out-of-network eye doctor and you have out-of-network benefits, your next step is to send us your completed claim form. You can now submit your form online or by mail:

By mail, you can print, complete and sign this claim form. If you are a Medicare member, you may use this form or just submit a written request with all information that would be on the form.

Most EyeMed Vision Care plans allow members the choice to visit an in-network or out-of-network vision care provider. You only need to complete this form if you are visiting a provider that is not a …

Out of Network Vision Claim Form Let's get started! To submit a claim please enter your email address below and we'll email you a link that will only be active for 24 hours. If you don't receive an email in …

Jan 1, 2024 · I hereby understand that without prior authorization from EyeMed Vision Care LLC for services rendered, I may be denied reimbursement for submitted vision care services for which I am …

If you choose an out-of-network provider, please complete the following steps prior to submitting the claim form to EyeMed. Any missing or incomplete information may result in delay of payment or the …

Use this form if you receive vision services from an out-of-network eye doctor and you have out-of-network benefits. If your plan does not include out-of-network benefits, please see the Network …