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  • Vsp Reimbursement Form

Get Vsp Reimbursement Form

Out-Of-Network Reimbursement Form Submit this form along with your itemized receipt to VSP P. O. Box 997105 Sacramento CA 95899-7105 IMPORTANT NOTE Your itemized receipt must include the information shown below with an. If your receipt does not contain this information your claim cannot be processed and you will need to contact your non-VSP provider for a new receipt which includes the required information. Member Information Member s ID or last .

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Most out-of-network providers will submit a request for reimbursement on behalf of VSP members. This means members won't need to pay their entire bill up front and will only be responsible for paying applicable copays and any balance above their out-of-network schedule.

If your benefits offer coverage for contacts, you'll have a plan allowance that will go towards the purchase of contacts. If you exceed your plan allowance, you'll be responsible for paying the coverage in addition to any applicable copays at the time of your visit.

We process your claim typically within seven (7) business days of submission, and send the reimbursement amount to your payroll department. Your payroll department will reimburse you via their standard payroll process.

VSP will never mail you a check and request that you wire a portion of the funds back. If you have received a VSP check that you believe to be fraudulent, please contact us at siumailbox@vsp.com or call our Anti-Fraud Hotline at 800.877.

You typically have 12 months from the date of service to submit for reimbursement. Failure to submit your out-of-network claim within 12 months of the date of service may cause your claim request to be denied. Please allow up to 10 business days (plus mailing time to and from VSP) for us to process your reimbursement.

Members can pay the provider directly and submit a claim to VSP for reimbursement, using the following procedure: A. Visit the Benefits & Claims section of vsp.com to begin a claim. Please note that claims for reimbursement must be filed within 12 months of the date of service.

Claims and Reimbursement Contact Member Services at 800.877. 7195 for help submitting a claim online or by mail. You don't need to fill out a claim form when you see a VSP network eye doctor or provider. The doctor or provider will submit the claim directly to VSP for processing after your appointment.

If there is a medical diagnosis, your VSP network doctor may also ask for your Medical ID Card. VSP does not generally give out ID Cards, but they are available online for you to print. You also have the ability to change your VSP account information.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232