Get the free Cole Vision Claim Form - MyABX

VISION CARE OUT OF NETWORK CLAIM FORM PROVIDER NO: PLAN NAME: PLAN NO: TO CHECK THE MEMBER'S BENEFITS CALL 1-800-359-8989 PATIENT NAME (Last Name, First Name) INSURED SOCIAL SECURITY NUMBER P INSURED

How to fill out cole vision claim form

1. The Cole Vision claim form is typically needed by individuals who have purchased eyewear or received eye care services covered by their vision insurance plan. This could include individuals who have visited a Cole Vision provider and are seeking reimbursement for expenses related to their eye care.
2. Start by obtaining a copy of the Cole Vision claim form. This form can usually be found on the website of the vision insurance company or by contacting the customer service department of the insurance provider.
3. Fill out the personal information section of the claim form. This typically includes providing your full name, address, contact information, and insurance policy or identification number. Make sure to double-check the accuracy of the information before submitting the form.
4. Indicate the date and details of your visit to a Cole Vision provider. This may require providing the name of the optometrist or optician you visited, the location of the office, and the date of service. If you have multiple visits or services to claim, make sure to provide accurate information for each one.
5. Describe the eyewear or eye care services you are claiming reimbursement for. This can include information such as the type of eyeglasses or contact lenses ordered, any upgrades or special features, and the total cost of the eyewear. If you had any additional eye care services, such as an eye exam or contact lens fitting, make sure to include those details as well.
6. Attach any necessary documentation to support your claim. This may include itemized receipts from the Cole Vision provider, a copy of the prescription, and any other relevant documentation that verifies the expenses incurred.
7. Review the completed claim form to ensure all the information provided is accurate and complete. Any missing or incomplete information could result in a delay or denial of your claim.
8. Make copies of the completed claim form and all supporting documentation for your records.
9. Submit the claim form and supporting documents to the vision insurance provider according to their specified submission method. This may include mailing the form or submitting it electronically through their online portal.
10. It's important to keep a record of when the claim form was submitted and to follow up with the insurance provider if you haven't received reimbursement or a response within a reasonable timeframe.

Remember, the specific requirements and procedures for filling out and submitting a Cole Vision claim form may vary depending on your vision insurance provider. It is always a good idea to review the instructions provided by your insurance provider or contact their customer service department for any additional guidance or clarification.

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