Avesis Out-of-Network Claim Form

You are only responsible for filing a claim if you receive vision care from a provider not participating in the Avesis network.

You are responsible for payment of services to the non-Avesis provider in full. Afterwards you must fill out the attached form and mail it along with your receipt to:

Avesis Third Party Administrators, Inc.
Vision Claims Department
PO Box 7777
Phoenix, AZ 85011-7777

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