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  • Davis Vision Direct Reimbursement Claim Form 2017

Get Davis Vision Direct Reimbursement Claim Form 2017-2025

FOR INTERNAL USE ONLY Auth #: PaidoDeniedoPendedoDirect 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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accepts most vision insurance plans, including VSP. However, your allowance may differ.

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.

Reimbursed up to $50 for frames, up to $30 for single vision lenses, up to $40 for bifocals, up to $60 for trifocals, up to $80 for lenticular (post-cataract) lenses. In lieu of spectacle lenses, you may select contact lenses.

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

Reimbursed up to $50 for frames, up to $30 for single vision lenses, up to $40 for bifocals, up to $60 for trifocals, up to $80 for lenticular (post-cataract) lenses. In lieu of spectacle lenses, you may select contact lenses. ... Medically necessary contact lenses will be covered in full with prior approval.

Davis Vision Plan provides access to care through private practice providers and national retailers, including: Visionworks, , Sam's Club, Walmart, For Eyes, and more.

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.

If you go out-of-network, pay the provider at the time of service, then submit a claim to Davis Vision for reimbursement, up to the following amounts: eye exam - $35 | frame and lenses - $55 | contacts lenses - $30 | visually required contacts - $80.

Only one claim per service may be submitted for reimbursement each benefit cycle, except for contact lenses. To request claim forms, please visit the Davis Vision website at www.davisvision.com or call 1-800-401-2581.

Contact Member Services at 800.877. 7195 for help submitting a claim online or by mail. The doctor or provider will submit the claim directly to VSP for processing after your appointment. The doctor or provider will discuss any copays or out-of-pocket expenses with you during your appointment.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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