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The Blue Vision Claim form is a vital resource for individuals who seek reimbursement for vision care services obtained from out-of-network providers. With its straightforward layout, this form simplifies the process of claiming your benefits, allowing you to submit your requests either online or by mail. For those using electronic devices, completing the online form offers a green alternative and expedites the payment process. It is essential to remember that any claims must be submitted within 12 months of receiving the service, ensuring timely processing. The form captures necessary details such as patient information, service dates, and itemized receipts, making it easy to fill out while also emphasizing the importance of accuracy in the provided data. While the form caters to out-of-network services, it encourages members to consider in-network providers for convenience and savings, such as reduced paperwork and significant discounts on exams and eyewear. Familiarizing yourself with the claim process can save time and add to the overall experience of maintaining your vision health.

Blue Vision Claim Example

Blue View VisionSM

Claim submissions made easy

If you saw an out-of-network eye doctor and you have out-of-network benefits, your next step is to send a completed out-of-network claim form. Here’s how:

Online

–OR– By mail

Click below to complete

Complete and

an electronic claim

return the following

form. Go green and

paperwork.

get paid faster.

 

Access Form

If you will be using electronic assistive devices to complete the form, please use the online form.

Claim forms must be submitted within 12 months of the date of service. For complete terms and conditions, review the claim form.

Stay in-network and save on your next visit*

CHOOSE AN EYE DOCTOR

With thousands of providers across the nation, you can see who you want to see, when and where you want to see them. Whether it’s an independent eye doctor, popular retailer or even online, you have options.

Easily find an eye doctor using the provider locator on your vision benefit member homepage. Search by location, store hours and more — and then schedule your appointment.**

PDF-1806-RM-646

WATCH IT ADD UP

Members who combine an eye exam and new glasses save an average of 72% off retail prices. †

NEVER PAY STICKER PRICE

Receive additional discounts like:††

•40% off additional pairs

•20% off non-prescription sunglasses

•Up to 20% off anything above your frame allowance

FORM FREE

When you stay in-network it’s easy to get an eye exam and get on with your day. There’s no paperwork to fill out or forms to file. Everything is done for you.

*Vision care services frequency may vary. Check your benefits to verify your frequency of services type. **At select in-network providers. †Savings comparison of EyeMed versus care without vision benefits. ††Discounts are not insured benefits and are available at participating in-network providers. Not all discounts are available at all provider locations. Discounts and benefits may vary. Check your benefits.

OUT OF NETWORK/INDEMNITY

Blue View VisionSM

VISION SERVICES CLAIM FORM

 

Claim Form Instructions

To request reimbursement, please complete and sign the itemized claim form. Return the completed form and your itemized paid receipts to:

Email: [email protected] | Fax: 866-293-7373

Mail: Blue View Vision, Attn: OON Claims, P.O. Box 8504, Mason, OH 45040-7111

Patient Last Name†

 

Patient First Name†

 

MI

 

 

 

 

 

Birth Date (MM/DD/YYYY)† Street Address†

City†

 

 

State†

 

Zip Code†

 

 

 

 

 

 

Patient Member ID #

Relationship to Subscriber

 

Self

Dependent

 

 

 

 

 

 

 

 

Doctor or Store Name where you received service†

Subscriber Last Name†

 

 

 

Subscriber First Name†

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

Birth Date (MM/DD/YYYY)

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

Vision Plan Name

 

 

Date of Service† (MM/DD/YYYY)

 

 

 

 

 

Vision Plan Group #

 

 

 

Subscriber Member ID #

 

 

 

 

 

 

 

 

 

†Required

 

 

 

 

 

 

 

continued 1

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

Request for Reimbursement

Enter Amount Charged.† Remember to include itemized paid receipts.†

Service Type

Amount

 

Lens Type

Please

Lens Options:

Amount

Charged

 

Check

(if purchased)

Charged

 

 

 

 

 

 

 

 

 

 

 

 

Exam

$

 

 

Single

 

 

 

 

Anti-Reflective

$

 

 

 

 

 

 

 

 

*92014*

 

 

 

*V2100*

 

 

 

 

*V2750*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refraction

$

 

 

Bifocal

 

 

 

 

Polycarbonate

$

 

 

 

 

 

 

 

 

*92015*

 

 

 

*V2200*

 

 

 

 

*V2784*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Frame

$

 

 

Trifocal

 

 

 

 

Scratch

$

 

 

 

 

 

 

 

 

*V2025*

 

 

*V2300*

 

 

 

 

*V2760*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Lens

$

 

 

Progressive

 

 

 

 

Tint

$

 

 

 

 

 

 

 

 

*S0500*

 

 

 

*V2781*

 

 

 

 

*V2745*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Lens

$

 

 

Prem Prog

 

 

 

 

UV

$

 

 

 

 

 

 

 

 

Fitting *92310*

 

 

 

*V278126*

 

 

 

 

*V2755*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lenses

$

 

 

Other

$

 

 

 

Roll and Polish

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*V2702*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter Total Amount Paid as shown on receipt,

$

 

 

excluding sales tax†

 

 

 

 

 

 

I hereby understand that without prior authorization from Blue View Vision Care LLC for services rendered, I may be denied reimbursement for submitted vision care services for which I am not eligible. I hereby authorize any insurance company, organization employer, ophthalmologist, optometrist and optician to release any information with respect to this claim. By signing this claim form, I certify that I have read the applicable claim fraud warnings included with this form, and that all the information furnished by me is true and correct.

Member/Guardian/Patient Signature (not a minor)†

 

Date

 

 

 

†Required

continued 2

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

Network Access Exceptions

We work hard to make sure that you have access to thousands of eye doctors across the nation. Whether it’s due to location or provider availability, you may need to go out-of-network to receive care.

If this applies to you, please complete the following form. If not, please skip this section.

Based from your home or office location, you have the right to obtain in-network level of benefits with an out-of-network provider when: (i) you cannot schedule a visit within two-weeks, (ii) you are unable to locate a participating provider within a 10- mile radius in an urban-suburban area, or (iii) you are unable to locate a participating provider within a 20-mile radius in a rural area. You must submit a claim form to EyeMed for reimbursement.

Caution, this option is not available when you choose to use an out-of-network provider due to (i) your preference, (ii) when your personal schedule does not permit you to schedule an appointment with an available provider in two-weeks, (iii) or you are outside of your home or office location. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

continued 3

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

Check the boxes that apply. I acknowledge that I fit into one or more of the following criteria:

I was unable to schedule a visit within two-weeks with a participating provider.

Please provide the participating provider’s name, location and contact information in which you attempted to schedule an appointment:

 

Provider Telephone

Provider’s Name

Number (000-000-0000)

 

Provider Street Address

City

State

Zip Code

I was unable to locate a participating provider within a 10-mile radius in an urban-suburban area.

Please provide the zip code in which you were attempting to locate a provider:

Zip Code

OR

I was unable to locate a participating provider within a 20-mile radius in a rural area.

Please provide the zip code in which you were attempting to locate a provider:

Zip Code

Should you fail to provide the requested information associated with the criteria you selected above, you agree that we can process your claim as

an out-of-network claim.

continued 4

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

State Fraud Warning Statements

Revision date 04/12/18

General Fraud Warning: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud and may be subject to fines and confinement in prison.

For the states of AL, AK, AZ, AR, CA, CO, DE, DC, FL, GA, HI, ID, IN, KS, KY, LA, MA. MD, ME, MN, NC, NE, NH, NJ, NM, NY, OH, OK, OR, PA, PR, RI, TN, TX, VA, VT, WA and WV, please refer to the following fraud notices:

Alabama: Any person who knowingly presents a false or fraudulent claim for payment of loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution, fines or confinement in prison, or any combination thereof.

Alaska: A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false, incomplete, or misleading information may be prosecuted under state law.

Arizona: For your protection, Arizona law requires the following statement to appear

on this form: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.

Arkansas, Louisiana, Rhode Island, West Virginia: Any person who knowingly presents a false or fraudulent claim for payment of loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

California: For your protection, California law requires the following to appear on this

form: Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Colorado: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company

who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

continued 5

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

Delaware: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony.

District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

Florida: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

Georgia, Vermont: Any person who with intent to defraud or knowing that he/ she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud.

Hawaii: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment, or both.

Idaho: Any person who knowingly, and with intent to defraud or deceive any insurance company, files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony.

Indiana: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or misleading information commits a felony.

Kansas: Any person who with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud as determined by a court of law.

Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material there to commits a fraudulent insurance act, which is a crime.

Maine, Tennessee, Washington: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

continued 6

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

Maryland: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Massachusetts: Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, may be committing a fraudulent insurance act, which may be a crime and may subject the person to criminal and civil penalties.

Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.

Nebraska: Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing false, incomplete or misleading information is guilty of insurance fraud.

New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in RSA 638:20.

New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.

New York: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any material fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

New Mexico: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties.

North Carolina: Any person with the intent to injure, defraud, or deceive an insurer or insurance claimant is guilty of a crime (Class H felony) which may subject the person to criminal and civil penalties.

continued 7

OUT OF NETWORK/INDEMNITY VISION SERVICES CLAIM FORM

Ohio: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

Oregon: Any person who knowingly, and with intent to defraud any insurance company or other persons files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, may be subject to prosecution for insurance fraud.

Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Puerto Rico: Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation with the penalty of a fine of not less than five thousand ($5,000) and not more than ten thousand ($10,000), or a fixed term of imprisonment for three (3) years, or both penalties. Should aggravating circumstances be present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years.

Texas: Any person who knowingly presents a false or fraudulent claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Virginia: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated state law.

8

Click for Blue Vision Claim File

File Breakdown

Fact Name Details
Submission Methods You can submit the Blue Vision Claim form online or by mail.
Time Limit Claims must be submitted within 12 months of the service date.
Email and Fax Submit claims via email at [email protected] or fax to 866-293-7373.
Mailing Address Mail claims to Blue View Vision, Attn: OON Claims, P.O. Box 8504, Mason, OH 45040-7111.
Required Information Your completed form must include itemized paid receipts and personal details like your name and date of service.
Governing Law Claims are subject to the laws of the state where service was received.

Guide to Using Blue Vision Claim

After locating an eye doctor and receiving your eye care services, you may need to file a claim for reimbursement if you visited an out-of-network provider. To ensure you receive your benefits, follow these straightforward steps to fill out the Blue Vision Claim form. Completing the form accurately is essential for a smooth claims process.

  1. Obtain the Blue Vision Claim form from the official website or access it directly online.
  2. Begin filling out the required personal information including:
    • Patient’s last name
    • Patient’s first name
    • Middle initial
    • Birth date (MM/DD/YYYY)
    • Street address, city, state, and zip code
    • Patient Member ID number
    • Relationship to subscriber (Self or Dependent)
  3. Next, provide details regarding the service:
    • Doctor or store name where services were rendered
    • Subscriber’s last name and first name
    • Subscriber’s middle initial and birth date
    • Subscriber's street address, city, state, and zip code
    • Vision plan name
    • Date of service (MM/DD/YYYY)
    • Vision plan group number
    • Subscriber member ID number
  4. Enter the amounts charged for each type of service received.
    • Fill in the amounts for the exam, refraction, frame, contact lens fitting, and any applicable lens types and options.
    • Don’t forget to include total amount paid excluding sales tax, as shown on your receipt.
  5. Sign the claim form, ensuring your signature and the date are correct. Make sure you understand the statements regarding reimbursement eligibility and fraud warnings.
  6. Gather your itemized paid receipts and ensure they are attached to your claim form.
  7. Submit the completed claim form and receipts via one of the following methods:
    • Email: [email protected]
    • Fax: 866-293-7373
    • Mail: Blue View Vision, Attn: OON Claims, P.O. Box 8504, Mason, OH 45040-7111

By following these steps carefully, you will facilitate the claims process. Make sure to keep a copy of your submitted materials for your records. If you encounter any issues, customer service representatives are available to assist you in resolving questions or concerns regarding your claim.

Get Answers on Blue Vision Claim

What is the Blue Vision Claim form, and when should I use it?

The Blue Vision Claim form is used to request reimbursement for vision care services when you visit an out-of-network eye doctor. If you have out-of-network benefits, you will need to fill out this form to receive payment for the services rendered. Remember to submit your claim within 12 months of the date of service to ensure timely processing.

How do I submit the Blue Vision Claim form?

You have two options for submitting your claim:

  1. Online: Complete the claim form electronically. This method helps reduce paperwork and can expedite the payment process.
  2. By Mail: Print the completed form and send it along with your itemized receipts to the appropriate address. Make sure to include all requested information to avoid delays.

You can also use email or fax if you prefer those methods. Be sure to check the specific submission guidelines outlined on the form.

What information do I need to provide on the claim form?

To fill out the Blue Vision Claim form correctly, you must include the following information:

  • Patient's name, birth date, and address
  • Patient's member ID number
  • Doctor or store name where you received the service
  • Subscriber's details, including name and member ID
  • Date of service and the amount charged
  • Itemized receipts for all services and products purchased

Completing the form accurately helps in processing your claim quickly.

What happens if I don't submit my claim on time?

Claim submissions must be made within 12 months from the date of service. If you miss this deadline, you may not receive reimbursement for the services provided. It's crucial to keep track of your appointments and the date of service to avoid any issues with your claim submission. If you find that you are nearing this deadline, it's advisable to submit your claim as soon as possible to ensure that you are eligible for reimbursement.

Common mistakes

Filling out the Blue Vision Claim form is a critical step for individuals seeking reimbursement for vision care services. However, many people make mistakes that can delay the process or lead to a denial of their claims. Understanding these common errors can help ensure a smoother submission experience.

One frequent mistake is incomplete information. Claimants often skip required fields such as the patient’s member ID number or the date of service. Omitting this information can cause delays, as the processing team may need to reach out for clarification before moving forward with the claim. To avoid this, individuals should carefully check all sections of the form and ensure that all necessary details are filled out complete and accurately.

Another common error involves the submission of non-itemized receipts. The claim form explicitly states that itemized receipts must accompany the submission. Failing to provide these supporting documents can jeopardize the claim. It is essential for individuals to collect itemized receipts at the time of service and submit them alongside the claim form to facilitate a timely reimbursement process.

Furthermore, some claimants neglect to sign the form before submission. An unsigned form is not valid and will be rejected by the processing team. Many applicants may believe that entering their information is sufficient, but without a signature, the form lacks authenticity. Individuals should always double-check to ensure their signature is present before sending the form.

Lastly, another mistake is related to submitting the claim after the deadline. Claim forms must be submitted within 12 months from the date of service to be considered valid. People often forget when they received their services or miscalculate the timeline. It is advisable to set reminders or keep a timeline of services received to prevent this common oversight. By being mindful of these critical components, individuals can enhance their chances of a successful claim submission.

Documents used along the form

When you are submitting a Blue Vision Claim form for out-of-network vision services, you may also need to complete a few additional documents. Each serves a specific purpose in helping to ensure that your claim is processed smoothly and efficiently. Below are some of the common forms and documents you might encounter:

  • Itemized Paid Receipts: This document should detail the services provided, including the date of service and the amounts paid. It confirms what you are claiming reimbursement for and must accompany the claim form.
  • Proof of Payment: This can be a bank statement or a receipt showing that payment was made for the services. Including this document strengthens your claim by verifying that you paid for the service received.
  • Vision Plan Explanation of Benefits (EOB): If applicable, this document explains what your vision plan covers and what out-of-network benefits you may be entitled to. It provides clarity on your coverage and helps avoid misunderstandings during the claim process.
  • Authorization Form: Some insurance plans may require you to fill out an authorization form before receiving out-of-network services. This form provides permission for the insurance company to access your medical information for claim processing.
  • Member Identification Card: Often, you may need to submit a copy of your member ID card with your claim. This confirms your membership in the vision plan and helps in the identification of your account.
  • Cover Letter: While not always necessary, a cover letter can explain any unique circumstances related to your claim. This additional context may prevent any delays in processing.

Getting your claim processed quickly can make a big difference, both financially and in how you access future services. Ensuring you have all necessary documents in order will help you navigate this process with confidence. Always keep copies of everything you submit for your records.

Similar forms

The Blue Vision Claim form shares similarities with several other documents. Here’s how:

  • Health Insurance Claim Form (CMS-1500): This form, used primarily for medical claims, requires the patient’s details, provider information, and service descriptions. Both forms need accurate completion for reimbursement from insurers.
  • Dental Claim Form: Just like the Blue Vision form, the dental claim form requires information about services rendered, patient details, and itemized billing. Both aim to secure reimbursement for services received outside of preferred networks.
  • Out-of-Network Claim Form: This type of form requests reimbursement for services from non-participating providers. It shares similar instructions and submission processes, emphasizing the need for itemized receipts.
  • Medicare Claim Form: When submitting claims under Medicare, patients must provide service details and supporting documentation. Similarities include the necessity for a signature and submission within a specific timeframe to facilitate payment.
  • Flexible Spending Account (FSA) Claim Form: This form is used to request reimbursements for eligible expenses. Like the Blue Vision form, it requires itemized receipts and adherence to submission guidelines to ensure timely processing.

Dos and Don'ts

When filling out the Blue View Vision Claim form, keeping track of essential dos and don'ts can make the process smoother. Here are some key tips to guide you.

  • Do submit your claim within 12 months of the date of service to ensure reimbursement.
  • Do include all required information such as patient details, service dates, and the amount charged.
  • Do attach itemized paid receipts to your claim form for review and processing.
  • Do double-check your information for accuracy before submitting your claim.
  • Don't forget to sign the claim form; an unsigned form may lead to delays.
  • Don't leave out any required fields; omissions can result in denial or delay.
  • Don't use the out-of-network claim process if you have access to an in-network provider.
  • Don't submit claims using outdated forms; always use the latest version available.

Misconceptions

Misunderstandings about the Blue Vision Claim form can lead to confusion and potential delays in receiving reimbursement for vision services. Here are seven common misconceptions:

  • The claim form can be submitted anytime after the service date. Many people believe they have unlimited time to submit their claims. In reality, forms must be submitted within 12 months of the date of service to be eligible for reimbursement.
  • You don’t need to provide receipts for your claims. Some assume that filling out the claim form is enough. However, you must include itemized paid receipts to prove the expenses incurred for vision services.
  • Online submissions are not available for the claim form. Contrary to this belief, you can complete and submit your claim form online, which makes the process faster and more environmentally friendly.
  • Out-of-network benefits mean you can’t get any reimbursement. Many think that using an out-of-network provider excludes them from any reimbursement. If you have out-of-network benefits, completing the form accurately can result in reimbursement for eligible services.
  • The claim is automatically approved once submitted. Some individuals expect immediate reimbursement and assume the process is seamless. Each claim undergoes a review process, and reimbursement is not guaranteed unless eligibility criteria are met.
  • There is no need to check for in-network providers. A common misconception is that you should always go out-of-network. Using in-network providers can save you money and eliminate the need for paperwork, making it easier to receive services.
  • All discounts apply regardless of the provider visited. People often believe they can receive all advertised discounts with out-of-network providers. Discounts are typically available only through participating in-network providers, so checking your benefits is essential.

Key takeaways

When filling out and submitting the Blue Vision Claim form, consider the following key takeaways:

  • Timeframe for Submission: Claims must be submitted within 12 months from the date of service. Ensure you adhere to this deadline to avoid denial of reimbursement.
  • Complete Documentation: Include itemized paid receipts with your claim form. This helps verify the services purchased and the associated costs.
  • Submission Methods: You can file your claim online for quicker processing or opt to mail or fax your completed form and receipts to the designated addresses provided.
  • Access to Benefits: If you must visit an out-of-network provider, be aware of specific conditions that allow for in-network level benefits and the criteria to qualify for this option.