Aetna vision claim form 2025

1. Click ‘Get Form’ to open the Aetna Vision Claim Form in the editor.
2. Begin by filling out the Patient Information section. Enter your last name, first name, middle initial, street address, city, state, zip code, birth date, and telephone number. Ensure all fields are completed accurately.
3. Next, provide Subscriber Information. This includes the subscriber's last name, first name, middle initial, street address, city, state, zip code, vision plan name and ID number.
4. In the Request For Reimbursement section, enter the amounts charged for services such as exams and lenses. If applicable, check the type of lenses purchased.
5. Attach itemized paid receipts from your provider to ensure proper reimbursement. Remember that handwritten receipts must be on the provider’s letterhead.
6. Finally, sign and date the claim form before submitting it to Aetna Vision at the provided address.

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