We work hard to make sure that you have access to thousands of eye doctors across the nation. When you visit one of our in-network eye doctors, you won’t have to submit a claim, we take care of all the paperwork. If you saw an out-of-network doctor and you have out-of-network insurance benefits, your next step is to send us your completed claim form. You can now submit your form online or by mail.
To submit an out-of-network claim request, you’ll need the following:
1. Patient and Subscriber Information
- Last Name
- First Name
- Date of Birth
- Street Address
- City
- State
- Zip Code
2. Doctor or Store Information
- Name
- Street Address
- City
- State
- Zip Code
3. Itemized Receipt
Don’t wait to submit your claim - forms must typically be submitted within 15 months of the date of service to receive reimbursem*nt*.
To access the out-of-network form or to check the status of a claim, log in to your Member Web account and navigate to the Claims tab.
ACCESS FORM
If you are a Medicare member, you may use the Out-Of-Network claim form or submit a written request with all information listed above and mail to:
First American Admisinstrator, Inc.
Att: OON Claims, PO Box 8504, Mason OH, 45040-7111
*Out-of-network form submission deadlines may vary by plan. Log in to your account to confirm your specific plan submission deadline.
