Get Cigna Vision Claim Form - Lens.com

Filing a claim using the Cigna Vision Claim Form is a straightforward process designed for subscribers and covered dependents who have received services from providers outside the Cigna Vision network. This guide will provide you with step-by-step instructions to fill out the form accurately and ensure timely processing of your claim.

Follow the steps to complete the Cigna Vision Claim Form online.

1. Press the ‘Get Form’ button to access the Cigna Vision Claim Form and open it in your preferred editing tool.
2. Fill out the Patient Information section, including the patient's last name, first name, street address, city, middle initial, state, identification number or social security number, postal code, telephone number, birth date, and sex. Ensure that all fields are completed to avoid delays.
3. In the Subscriber Information section, provide the subscriber's last name, first name, street address, city, middle initial, state, identification number or social security number, postal code, telephone number, birth date, sex, employer name, insurance plan name, and subscriber’s group number.
4. Indicate any other health benefit plan by answering yes or no and attach any relevant Explanation of Benefits received from other insurance providers.
5. Complete the Request for Reimbursement section by detailing the amounts charged for the exam, frames, lenses, and contacts. Make sure to include an original itemized receipt that details all services and materials received.
6. In the Provider Information section, enter the provider's name, address, and telephone number.
7. Sign and date the claim form at the bottom, ensuring that you acknowledge the Fraud Warning statement.
8. Finally, once you have reviewed and confirmed the accuracy of the information, save your changes, download, print, or share the completed form as needed.

Complete your claim forms online for efficient processing and secure your vision benefits today.