Served from Node: G-3U6MOS0BYX44K
Avesis
As the impact of coronavirus grows, we would like to provide some important updates and to assure you that you are our top priority. Providers and Benefits Managers, please log into your account to learn more. Members, click here to learn more.

Avesis Out-of-Network Claim Form

Members are only responsible for filing a claim if they receive vision care services from a provider that is not currently participating in the Avesis network. At point of service, the member would be responsible for making payment-in-full of all charges to the non-Avesis provider. Afterwards, to receive reimbursement up to the plan specified schedule of allowances, members must fill out the attached form and mail it along with their receipts to:

Avesis Third Party Administrators, Inc.
Vision Claims Department
P.O. Box 38300
Phoenix AZ 85069-8300

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