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| VISION |
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| Filing
a Claim |
When you receive out-of-network care, you must pay your provider in
full for all services and materials. You then complete and submit an
Out-Of-Network
Claim Form. Please follow the instructions provided on the
form and include your itemized receipt to EyeMed that shows the cost
or charges for the eye examination, lens type and frame. You should
be sure to include your name, mailing address, EyeMed member identification
number and the Valassis group number. If the services are for a covered
family member, you should also include the patient's name, relationship
to you and date of birth.
If your provider is not currently an EyeMed provider, you can nominate
him/her to EyeMed. Please complete a Nomination
Form and forward it to the e-address or fax number on the form.
Claims for out-of-network reimbursement must be provided to EyeMed
within 12 months of the date of service:
EyeMed Vision Care
Attn: Out-of-Network Claims
P.O. Box 8504
Mason, OH 45040-7111
Fax completed form and supporting documentation to: 866-293-7373
or email to oonclaims@eyemedvisioncare.com
www.eyemedvisioncare.com
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