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Insurance Reimbursement Forms

Insurance Reimbursement Forms

Do You Have Vision Insurance?

Heavyglare.com is an out-­of-­network provider for most vision insurance plans

 

You can submit your Heavyglare.com eyewear or contact lens purchase for reimbursement in three easy steps!

  1. Completethe Out-of-Network Reimbursement Form for your provider. We have included forms for the most popular providers below, and a blank form for other providers.
  2. Attachyour itemized Heavyglare.com order receipt or invoice (which will be emailed to you and also included in your package).
  3. Submitthe receipt and form to your vision insurance company.

 

If you do not see your insurance provider listed below, use thisgeneric reimbursement formto submit your claim.


Insurance Providers

Click on your insurance provider below for details on how to submit your insurance claim form.



Advantica


You can get your Heavyglare.com purchase reimbursed by Advantica if out-of-network benefits are included in your plan. You canreview your benefits hereor by calling 1-866-425-2323.

Submit your completed reimbursement form and itemized Heavyglare.com receipt to:

Advantica
Attn: Claims Department
3290 Pine Orchard Lane, Suite C
Ellicott City, MD 21042

NOTE: You must submit your out-of-network reimbursement request within one year from the date of purchase.



Always Care


You can get your Heavyglare.com purchase reimbursed by AlwaysCare if out-of-network benefits are included in your plan. You canreview your benefits hereor by calling1-888-729-5433.

Submit your completed reimbursement form and itemized Heavyglare.com receipt to:

AlwaysCare
Attn: Claims Department
8485 Goodwood Blvd
Baton Rouge, LA 70806-7878

NOTE: You must submit your out-of-network reimbursement request within one year from the date of purchase.




Davis Vision

You can get your Heavyglare.com purchase reimbursed by Davis Vision if out-of-network benefits are included in your plan. You canreview your benefits hereor by calling 1-800-999-5431.

Submit your completed reimbursement form and itemized Heavyglare.com receipt to:

Vision Care Processing Unit
P.O. Box 1525
Latham, NY 12110

NOTE: Your out-of-network reimbursement form must be submitted within 180 days from the date of purchase.




EyeMed


You can get your Heavyglare.com purchase reimbursed by EyeMed if out-of-network benefits are included in your plan. You canreview your benefits hereor by calling 1-866-4EyeMed (439-3633)

Submit your completed reimbursement form and itemized Heavyglare.com receipt to:

EyeMed Vision Care
Attn: OON Claims
P.O. Box 8504
Mason, OH 45040-7111

NOTE: You must submit your out-of-network reimbursement request within one year from the date of purchase.




Humana Vision


You can get your Heavyglare.com purchase reimbursed by Humana Vision if out-of-network benefits are included in your plan. You canreview your benefits hereor by calling 1-866-537-0229.

Submit your completed reimbursement form and itemized Heavyglare.com receipt to:

Humana Vision Care Plan
Attn: OON Claims
P.O. Box 14311
Lexington, KY 40512-4311

NOTE: You must submit your out-of-network reimbursement request within one year from the date of purchase.


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