If you see an in-network provider but choose to take advantage of a sale, coupon, or other in-store special, the provider may require that you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates.
If you have co-pays, these are paid to your in-network provider at the time of your visit. You are also responsible for paying for any services or materials that are not covered or that exceed your benefit plan coverage. If you paid in full for your service, please provide a brief explanation as to why your provider did not bill us on your behalf.
Mail a copy of the itemized invoice or receipt imprinted with the provider’s name and address along with this form to the contact information below. Please retain the original for your records.
Attn: Claims Processing
P.O. Box 967
Rancho Cordova, CA 95741
Questions? Please call our Customer Service department at (800) 507-3800