Out of network claims submissions made easy

We work hard to make sure that you have access to thousands of eye doctors across the nation. When you visit one of our in-network eye doctors, you won’t have to submit a claim, we take care of all the paperwork. If you saw an out-of-network doctor and you have out-of-network insurance benefits, your next step is to send us your completed claim form. You can now submit your form online or by mail.

To submit an out-of-network claim request, you’ll need the following:

1. Patient and Subscriber Information

• Last Name
• First Name
• Date of Birth
• Street Address
• City
• State
• Zip Code

2. Doctor or Store Information

• Name
• Street Address
• City
• State
• Zip Code

3. Itemized Receipt

Don’t wait to submit your claim - forms must typically be submitted within 15 months of the date of service to receive reimbursement*.

To access the out-of-network form or to check the status of a claim, log in to your Member Web account and navigate to the Claims tab.

ACCESS FORM

If you are a Medicare member, you may use the Out-Of-Network claim form or submit a written request with all information listed above and mail to:

First American Admisinstrator, Inc.

Att: OON Claims, PO Box 8504, Mason OH, 45040-7111

*Out-of-network form submission deadlines may vary by plan. Log in to your account to confirm your specific plan submission deadline.