Get Aetna Out-of-network Vision Services Claim Form 2009
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How to fill out the Aetna Out-of-Network Vision Services Claim Form online
Navigating the Aetna Out-of-Network Vision Services Claim Form can seem challenging, but this guide will provide you with clear instructions on how to complete it effectively online. By following these steps, you can ensure your claim is submitted accurately and promptly.
Follow the steps to complete the claim form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill in your patient information. Include details like your last name, first name, middle initial, street address, city, state, zip code, birth date, telephone number, and member ID. Ensure all required fields are complete.
- Provide the subscriber information, which includes the last name, first name, middle initial, street address, city, state, zip code, birth date, and vision plan details. All entries must be carefully checked for accuracy.
- Enter the date of service in the required format (MM/DD/YYYY). This is crucial as it may determine eligibility for reimbursement.
- Request reimbursement by entering the amounts charged for each service: exam, frame, and lenses. If lenses were purchased, indicate the type by checking the corresponding box.
- Include itemized paid receipts that show the services provided and the total amount charged. Handwritten receipts must be on the provider's letterhead and verify that services were paid in full.
- If applicable, attach a copy of the Explanation of Benefits for submission under a secondary insurance benefit.
- Sign the claim form in the designated area, ensuring that the signature is from the member, guardian, or patient (if not a minor).
- Return the completed form along with all necessary attachments to Aetna Vision at the specified address. Keep a copy of your submission for your records.
- After submitting, allow at least 14 calendar days for processing. You will receive a check and/or explanation of benefits within seven days from the processing date.
Take the first step towards reimbursement by completing your Aetna Out-of-Network Vision Services Claim Form online today.
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Aetna vision reimbursement typically involves submitting a claim after you've received services from out-of-network providers. Use the Aetna Out-of-Network Vision Services Claim Form to supply all necessary details for processing. After you submit your claim, Aetna reviews it and sends reimbursement according to your plan’s terms. Knowing how this process works helps you navigate your benefits more effectively.
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