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Out-Of-Network Claim Form - Aetna

Out-Of-Network Claim Form - Aetna

member.aetna.com

Out-Of-Network Claim Form Aetna Vision plans allow members the choice to visit an in-network or out-of-network vision care provider. You only need to complete

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UnitedHealthcare Vision® Vision Plan Out-of-Network Claim …

UnitedHealthcare Vision® Vision Plan Out-of-Network Claim …

www.uhc.com

Vision Plan Out-of-Network Claim Form Please return this form with a copy of your paid, itemized receipt to: UnitedHealthcare Vision ATTN: Claims Department P.O. Box 30978 Salt Lake City, UT 84130 Fax: (248) 733-6060 Questions? You can call our Customer Service Department at (800) 638-3120

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