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How to use or fill out Blue View Vision Out-of-Network Claim Form - Anthem with DocHub
- Click ‘Get Form’ to open the Blue View Vision Out-of-Network Claim Form in our editor.
- Begin by filling out the 'Patient Information' section. Enter your last name, first name, middle initial, street address, city, state, zip code, birth date, telephone number, and member ID number.
- Next, complete the 'Subscriber Information' section with the subscriber's details including their last name, first name, middle initial, and vision plan information.
- In the 'Request For Reimbursement' section, input the amounts charged for services such as exams and lenses. Ensure you check the type of lenses if applicable.
- Attach itemized paid receipts from your provider to the claim form. Make sure these receipts are clear and indicate services provided.
- Finally, sign and date the claim form at the bottom before submitting it via mail or email as instructed.
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