Submit an Out-of-Network Claim - VSP Vision Care
There are no claim forms to fill out when you see a VSP network doctor. Before your next visit, find a VSP network doctor near you to help keep your eyes healthy and your wallet happy. …
Write the amount of the Laser Vision Care claim under “Exam” on the reimbursement form.
To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. Be sure to keep a copy for your records.
VSP Request for Reimbursement Form - printfriendly.com
View the VSP Request for Reimbursement Form in our collection of PDFs. Sign, print, and download this PDF at PrintFriendly.
To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. Be sure to keep a copy for your records.
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.
VSP Member Reimbursement Form To request reimbursement, complete this form (in blue or black ink), enclose a legible copy of your itemized receipt(s), and send them to the following …
File a Claim for Reimbursement - VSP Vision Care
Find information on how to submit a claim for in-network reimbursement or out-of-network reimbursement with VSP.
Write the amount of the Laser Vision Care claim under “Exam” on the reimbursement form.
To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. Be sure to keep a copy for your records.