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  • Direct Reimbursement Claim Form Important ... - Davis Vision

Get Direct Reimbursement Claim Form Important ... - Davis Vision

FOR INTERNAL USE ONLY Auth #: Paid Denied Pended Direct Reimbursement Claim Form Important Information: 1. Use this form to request reimbursement for services received from providers who do not participate.

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To submit a claim by mail, contact VSP Member Services at 800.877. 7195 to request a VSP Member Reimbursement Form. ... If you submit a claim online, you may also print and mail copies of your claim form and receipt(s) to the address below.

Davis Vision provides for 100 percent covered annual eye examination, driving wellness through early detection of vision problems. Davis Vision offers a one-year breakage warranty for repairs or replacement of plan-covered frames and/or lenses at no cost to members.

VSP Standard Option VSP's Standard Option plan comes with a $120 or $160 frame allowance. Get a $120 frame allowance toward the purchase of any frame brand, or get a $160 frame allowance on a featured frame brand. Click here to see a list of featured frame brands.

As with eyeglass frames, Davis Vision offers a special Collection of contact lenses to members, which greatly minimizes out-of-pocket costs. ... The contact lens evaluation, fitting and follow-up care will have a $60 allowance (less the $15 copay).

To submit a claim by mail, contact VSP Member Services at 800.877. 7195 to request a VSP Member Reimbursement Form. ... If you submit a claim online, you may also print and mail copies of your claim form and receipt(s) to the address below.

If you are interested in joining the Davis Vision network of eye care professionals, please click here and follow the online instructions. You may also contact us at 1 (800) 584-3140 to request an application. Submit the completed application and all requested paperwork.

With Davis Vision, you are free to choose any frames available at any participating private practice or retail location. You will receive a $130 allowance toward the cost of the frame. ... If you choose a Fashion or Designer frame from our Davis Vision Exclusive Collection it will be covered in full.

For more information about how to enter the system, call Davis Vision member services at 1 (800) 999-5431. You can also send an email at our contact form.

To request claim forms, please visit the Davis Vision website at www.davisvision.com or call 1-800-401-2581.

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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