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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. Complete the 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. Attach your itemized Heavyglare.com order receipt or invoice (which will be emailed to you and also included in your package).
  3. Submit the receipt and form to your vision insurance company.

 

If you do not see your insurance provider listed below, use this generic reimbursement form to 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 can review your benefits here or 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 can review your benefits here or by calling 1-888-729-5433.

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 can review your benefits here or 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 can review your benefits here or 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 can review your benefits here or 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.

Spectera

You can get your Heavyglare.com purchase reimbursed by Spectera if out-of-network benefits are included in your plan. You can review your benefits here.

Submit your reimbursement request and itemized Heavyglare.com receipt to:

Spectera Claims Department
P.O. box 30978
Salt Lake City, UT 84130

Or Fax: 248-733-6060

NOTE: You must submit your out-of-network reimbursement request with your itemized receipt and the following information: Subscribers name and address, the patients name and date of birth, and the subscribers unique identification number. This number can be found on your membership card, on the Spectera website, or by calling 1-800-638-3120. For convenience, you can complete our blank out-of-network reimbursement form.

Superior Vision

You can get your Heavyglare.com purchase reimbursed by Superior Vision if out-of-network benefits are included in your plan. You can review your benefits here or by calling 1-800-507-3800.

You will need to contact Superior Vision Customer service at 1-800-507-3800 to obtain an authorization number prior to using your out-of-network benefits. After obtaining out-of-network services, you will need to file a claim form as well as an itemized receipt.

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

Superior Vision Services
Attn: Claims Processing
P.O. Box 967
Rancho Cordova, CA 95741

Or Fax: 916-852-2277

Vision Benefits of America

You can get your Heavyglare.com purchase reimbursed by Vision Benefits of America if out-of-network benefits are included in your plan. You can review your benefits here or by calling 1-800-432-4966.

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

Vision Benefits of America
300 Weyman Plaza, Suite 400
Pittsburg, PA 15236-1588

VSP

You can get your Heavyglare.com purchase reimbursed by VSP if out-of-network benefits are included in your plan. You can review your benefits here or by calling 1-800-877-7195.

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

VSP
P.O. 997105
Sacramento, CA 95899-7105

Flexible Spending

Did you know that you can use your flexible spending or health savings accounts (HSA) dollars to purchase prescription eyeglasses, prescription contact lenses, and prescription sunglasses? These funds can be used for prescription eyewear, regardless of whether or not you have vision insurance. And if you use your flex spending or HSA debit card, you can skip the hassle of having to submit a reimbursement form to your insurance provider!

QUESTIONS?

Call one of our certified opticians at 800-548-0558 for more information about using your out-of-network benefits on your Heavyglare.com purchase!