How to submit a vision claim for reimbursement When you visit a VSP Choice network provider, the doctor will submit the claim directly to VSP for payment. If you are a member and are age 19 or older and you see an out-of-network provider, you pay 100 percent of the billed charges. You can submit the claim online or by mail. See the Directory pages at the beginning of this booklet for links and contact information. When you submit a claim, attach an itemized receipt that includes the following information: • Doctor’s name or office name; • Name of patient; • Date of service; and • Each service received and the amount paid. Timely submitting of claims You have 12 months from the date of service to submit your claim. If you do not submit your claim within 12 months of the date of service, it will be denied. If you disagree with how your claim was processed, you may file a complaint or an appeal. Vision complaints and appeals How to submit a vision complaint Complaints can be submitted through a written or verbal request. See the Directory pages at the beginning of this booklet for links and contact information. How to submit a vision appeal You have the right to appeal if: • You do not agree with VSP's decision about your health care. • VSP will not approve or give you care you feel it should cover. • VSP is stopping care you feel you still need. VSP normally has 30 days to process your appeal. In some cases, you have a right to an expedited appeal. You can get an expedited appeal if your health or ability to function could be seriously harmed by waiting 30 days for a standard appeal. If you ask for an expedited appeal, VSP will decide whether your request is approved. If not approved, your appeal will be processed in 30 days. If any doctor asks VSP to give you an expedited appeal, or supports your request for an expedited appeal, it must be given to you. If you want to file an appeal which will be processed within 30 days, do the following: File the request in writing with VSP. See the Directory pages at the beginning of this booklet for contact information. Your appeal request will be processed within 30 days from the date your request is received. If you want to file an expedited appeal, which will be processed within 24 hours, do the following: • File an oral or written request for an expedited appeal. Specifically state that "I am requesting an expedited appeal," or "I believe that my health could be seriously harmed by waiting 30 days for a normal appeal." • To file a request orally, contact VSP Member Services. VSP will document the oral request in writing. See the Directory pages at the beginning of this booklet for contact information. 84 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage