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How to file for Out-of-Network reimbursement

When services and/or materials are obtained from an open access provider, members have two reimbursement choices

1.  Members can ask an open access provider to submit a request for reimbursement on their behalf. This means members won’t need to pay their entire bill up front and will only be responsible for paying applicable copays and any balance above their open access schedule.

2.  Members can pay the open access provider directly and submit a request for reimbursement to VSP, using the following procedure:

a.  Pay the open access provider the full amount and request an itemized copy of the bill. The bill should separately detail the charges for the eye exam and materials, including lens type.

b.  Include the following information with the bill:

                           i.    The name, address, and phone number of the open access provider

                          ii.    The covered member's ID number

                         iii.    The covered member's name, address, and phone number

                         iv.    The name of the group

                          v.    The patient's name, date of birth, address, and phone number

                         vi.    The patient's relationship to the covered member (such as self, spouse, child, student, etc).

· Members can write the information on the bill or use the printable form available when members sign on to view benefits information at vsp.com.

c.     Send a copy of the itemized bill(s) with the above information to VSP at:

VSP

P.O. Box 997105
Sacramento, CA 95899-7105