How to Submit a VSP Claim for Out-of-Network Services
Navigate the VSP out-of-network claim process with ease. Get reimbursed for your eye care services.
VSP vision insurance offers benefits for eye care services, typically through a network of providers. If you receive services from an out-of-network provider, you’ll need to submit a direct claim for reimbursement. This process requires specific information and documentation. This guide explains how to submit your VSP claim for out-of-network services.
Preparing Your VSP Claim
Submitting a VSP claim for out-of-network services requires gathering all necessary information and documentation. You will need to compile details about the patient, the service provider, and the services rendered.
Collect the patient’s name, VSP member ID, and date of birth. Gather provider information, including their name, office name, address, and tax identification number. Accurate provider information helps VSP verify services.
Records of services received are also important. This includes the date(s) of service and a description of each service, such as an eye exam, frames, lenses, or contact lenses. Document the amount paid for each service or item.
An itemized receipt or service statement from the eye care provider is required. The receipt must list the provider’s name and address, date of service, description of each service or item, charge for each, and proof of payment. Missing elements can delay or deny your claim. For materials like contacts or frames, the doctor’s information may not be required, but purchase location details are needed.
VSP provides a member reimbursement form for out-of-network claims, available on their website or member portal. Once you have gathered all required information and the itemized receipt, transfer these details onto the claim form. Complete fields for patient demographics, provider information, dates of service, and charge breakdown. Claims should be submitted within 12 months from the date of service.
Submitting Your VSP Claim
After preparing your information and documentation, submit your VSP claim. VSP offers online and mail submission options. Each method requires attention to detail for efficient processing.
For online submission, log in to your VSP.com account and navigate to the claims section (e.g., “View Your Benefits” or “My Benefits”). Look for the out-of-network claim submission option. Input your information into the online portal.
Upload scanned copies of your itemized receipts and any other supporting documents. Review all entered information for accuracy, then finalize the submission. The system often provides a confirmation.
To submit your claim via mail, print the completed VSP member reimbursement form. Fill out all fields legibly, either typed or in blue or black ink. Include copies of your itemized receipts with the form. Send copies, not original documents, for your records.
The mailing address for VSP claims is on the claim form or VSP website. Common addresses include P.O. Box 385018, Birmingham, AL 35238-5018, P.O. Box 997105, Sacramento, CA 95899-7105, or P.O. Box 495933, Cincinnati, OH 45249. Using certified mail with a return receipt can provide proof of mailing and delivery. Missing information or incomplete forms can delay processing, so double-check everything before sending.
Following Up on Your VSP Claim
After submitting your VSP claim, monitor its progress to ensure reimbursement. VSP provides tools to track your claim’s status. Understanding processing timelines and notifications helps manage expectations.
Check your claim’s status through your VSP member portal. After logging in, find a “Benefits History” or “View Previous Visits” section displaying your claim’s progress. This tool shows if your claim has been received, is in process, or has been paid. If you encounter any issues or have questions, VSP Member Services can be contacted by phone.
VSP communicates the outcome of your claim through an Explanation of Benefits (EOB) statement. This document details how your claim was processed, including the services covered, the amount VSP paid, and any remaining patient responsibility. An EOB clarifies the financial aspects of your claim and your benefits application.
Claims are processed within 20 business days from the date of submission. If a check is issued, it typically mails one business day after the claim is marked “Paid” and can take up to 10 business days to arrive. Understanding these timelines helps you know when to expect a resolution or when to follow up if there are delays.