Say Hello to the Brandnew Davis Vision Mobile App TeamstersCare 25
Davis Vision Claim Form. Expenses for both examinations and eyewear can be claimed on this form. Each patient’s services must be claimed on a separate form.
Say Hello to the Brandnew Davis Vision Mobile App TeamstersCare 25
Expenses for both examinations and eyewear can be claimed on this form. To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. If a corrected claim has been attached, please specify revisions that were made: (choose one) ☐member ☐spouse ☐domestic partner. Only services listed on this form will be considered for reimbursement. Web direct reimbursement claim form important information: Only services listed on this form will be considered for reimbursement. This change aligns davis vision and superior vision with cms guidelines on paper claims submission. Davis vision complaints and appeals department p.o. Please submit to the following contact:
Follow the instructions on the form to submit your claim. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Letter of authorization from client / group; Each patient’s services must be claimed on a separate form. Client / group name the request is regarding; (choose one) ☐member ☐spouse ☐domestic partner. Be sure to keep a copy for your records. If a corrected claim has been attached, please specify revisions that were made: Only services listed on this form will be considered for reimbursement. Use this form to request reimbursement for services received from providers not in the davis vision network. Web davis vision by metlife member reimbursement form.
