These networks offer members a discount on LASIK services when using an in-network QualSight provider. To zoom out press COMMAND + MINUS SIGN (). Vision Wellness. Response to your written grievance will not exceed 30-days from receipt of the complaint. Some states require a specific grievance policy and procedure. Firefox PC: Select button labelled Firefox (orange) at top of screen > Options. Superior vision provides a $125- $200 frame allowance and covers in full single vision lenses, lined bifocals, and lined trifocals. Enter the information you wish to search on. The preferred option is to send your Grievance in writing (company specific form is not required) to: If you choose you may fax it to us at: 916-852-2290, or. . Attention: Claims Services. Site - Document Library. Learn More About QualSight LASIK University LASIK Specialists of Texas Your eyes deserve the best care from LASIK specialists you can trust. If you didnt find any eye care professionals it was probably because you made your search too narrow. The name and identification number of the member asking for the review; Names of health care providers or administrative staff involved; and. Upon request, your provider shall we will sent a copy of this grievance and appeals notice within five (5) business days after the date the appeal is initiated pursuant to an expedited medical review, expedited appeal, informal reconsideration and/or formal appeal. If you have a problem or concern regarding claims, you should first call the Superior Vision Plan Customer Service toll free number. Try to make your search more narrow by adding other information to the search. Questions? Information is not shared with organizations not an entity of Superior Vision Services, its Web delivery partner, software vendors, brokers or service eye care specialists. I am . We reserve the right at any time and periodically to modify this site, temporarily or permanently, or any part thereof, with or without notice. Superior Vision's SmartAlert Wellness Program fosters communication between you, your eye care provider, and your primary care physician or . Once the request is approved, a formal document outlining your account will be sent out via fax or email. However, with our preconfigured online templates, things get simpler. We collect Click-stream data, HTTP Cookies. Who We Serve We are proud to serve over 38.5 million client members through our third-party government and health plan relationships. Please contact us if you have any issues accessing information on this website. Date: Rehabilitation Act. Superior Vision is a vision insurance company focused on providing quality eye care and treatment, rather than simply offering savings on eyewear. Denial Reversed If we agree that the covered services should have been provided, or that the claim should have been paid we will authorize the service or pay the claim. We are currently experiencing technical issues impacting our service operations, including our member and provider portals. How do I find a network provider? Access the most extensive library of templates available. The IHCP reimburses opticians (specialty 190) and optometrists (specialty 180) only for services . Superior Vision Benefit Management, Inc., Superior Vision of New Jersey, Inc., Superior Vision Insurance Plan of Wisconsin, Inc., UVC Independent Practice Association, Inc., Superior Vision Services, Inc., and Block Vision of Texas, Inc. d/b/a Superior Vision of Texas and their affiliates (collectively, Superior Vision) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Use your browsers print option. CMS-1500 forms can be purchased at local office supply stores or by calling the U.S. Government Printing Office at (866) 512-1800. In most cases, LASIK is performed on both eyes and completed within minutes. For immediate situations where a member may have lost or damaged his or her contact lenses or eyeglasses and the member is out-of town, a customer service representative may facilitate directing the member to a contracted provider in the area. As a result it may not always be 100% up-to-date. Ensure everything is filled out appropriately, without any typos or absent blocks. As some content on this site is provided by other organizations and web content providers, Superior Vision cannot and does not guarantee the accuracy, timeliness and/or source of information from these organizations. Gold Preferred Plan Services Frequency Structural markup to indicate headings and lists (semantics) to aid in page comprehension. Contact Us | Find an Eye Care Professional | Disaster Relief. To change foreground and background colors: We are trying to make our website as accessible as possible for all of our visitors. Within five (5) business days after receiving a notice of decision from the independent review organization, the director shall mail a notice of the decision to Superior Vision, the health insurer, the member and the members treating provider. Superior Vision Services11101 White Rock, Suite #150Rancho Cordova, CA 95670. You must have a printer configured. Any other matter pertaining to the contractual relationship between a Covered Person and the Insurer. Disclaimer: Versant Health, Inc.s and each of its subsidiaries (together, Versant Healths) policies and procedures (P&Ps) are confidential and proprietary, and are subject to change at any time. See below for search help. Details of the attempt that was made to resolve the problem. You can enter a new search by hitting the New Search image. Eliminate the routine and produce paperwork online! For a full copy of our policy, please click here to request it. This policy is for when members have questions or concerns about the quality of vision care that they receive, or have an issue with a claim. Medicare, Medicaid, CHIP, Tricare, Health Insurance Marketplaces, Language Assistance Program, Language Assistance: Espaol | | Ting Vit | | Tagalog | | | Deutsch | | | Other Languages. Your request for a grievance review should include: A Grievance may be submitted to us by or on behalf of a Covered Person within one year of the date of treatment, event or circumstance giving rise to the Grievance, such as the date of the claim denial. Use this form for reimbursement for services received from an out-of-network provider, . Forms 10/10, Features Set 10/10, Ease of Use 10/10, Customer Service 10/10. Internet Explorer: Select Tools > Internet Options > General dialog page, and the Colors button. You may have an interpreter made available to you free of charge to facilitate your conversation with your eye care professional or Superior Vision. You may obtain a replacement notice outlining this grievance and appeals process by contacting Superior Vision Services Customer Service Department at (800) 507-3800. Ensures that a website is free of malware attacks. If you would like more information about PDF accessibility, visit the Adobe website accessibility section. Inappropriate use of a modifier or using a modifier when it is not necessary will result in denial or a delay of claim reimbursement. 4. We strongly advise members to always seek the advice of a vision/eye care professional with any questions about vision and eye care or any medical condition. You also may request additional cards by calling Superior Vision Customer Service at (877) 396-4128. We've copied your review, after you click 'Publish' please paste your review by selecting 'ctrl' + 'v' into the review comments section. Author: j1tencati Created Date: 4/30/2018 5 . Superior Vision. Box 385018. Please refer to the following Superior Payer Fee Schedules for therapy reimbursement amounts: If you have additional questions regarding these fee schedule changes, please contact Provider Services at 1-877-391-5921 or your Account Manager. Call Superior Vision Customer Service at (800) 507-3800, and someone who speaks your language can help you. Member Reimbursement Claim Form Use this form for reimbursement for services received from an out-of-network provider or when you ve utilized an in-store sale or promotion from an in-network provider. Depending on your benefit coverage, a LASIK discount or allowance may be included. Materials co-pay applies to lenses and/or frames, not contact lenses. Click on the Search button or hit Enter to begin the search. In addition to the information below, you can email our privacy officer at. Please call our Customer Service department at (800) 507-3800 12-2019. Tambin podemos proporcionarle material en espaol acerca de sus beneficios. A cookie is an element of data that a website can send to your browser, which may then store it on your system. Call 1 (877) 201-3602 for a free LASIK consultation. Personal Attendant Services. We collect this data for the purpose of site administration, completing the users current activity, and site customization. Superior Vision automated phone service is available 24/7. If prompted while searching a Superior Vision provider, select "Superior National" as the network and "Insurance through your provider" for coverage type. Plug-ins: Adobe Flash Player, Adobe Acrobat Reader, Windows Media Player. Guarantees that a business meets BBB accreditation standards in the US and Canada. If you call seeking services for an Emergency or Urgent Medical Condition, or an immediate situation a customer service representative will direct you as follows: If you have a problem or concern, you should first call the Superior Vision Plan customer service toll free number shown on your ID card. Once your request is received, we will research the case in detail, ask for more information as needed and let you know, in writing, of the decision or the outcome of the investigation into your case. Get your online template and fill it in using progressive features. Box 967 u Rancho Cordova u California 95741 u 800-507-3800 u www.superiorvision.com . Tenemos intrpretes en espaol, chino, vietnamita, tagalo y coreano. ERISA provides that if your claim for a welfare benefit is denied, in whole or in part, you have the right to know why this was done, to obtain copies of all documents relating to the decision without charge, and to contest any denial, all within certain time schedules. Moreover, you get full coverage for lenses, including polycarbonate. The Superior Vision Plan is a vision care program designed to offer a high-level of vision care to you and your family. These P&Ps are not intended to dictate medical care decisions, and they do not and should not be interpreted as a substitute or replacement for a treating physicians prudent clinical judgment at the time vision services are delivered to a patient. Scheduling an appointment and understanding your benefits is simple. We built it for you - with access to over 104,000 in network eye care professionals and 50 of the top 50 major retail optical chains, we have you covered. Tip: Missing information and receipts can delay your reimbursement. If the director finds that the case involves a medical issue or is unable to determine issues of coverage, the director shall submit the members case to the external independent review organization in accordance with section E (above) or K (below). Your eyes deserve the best care from LASIK specialists you can trust. Vision Plan Out-of-Network Claim Form Please return this form with a copy of your paid, itemized receipt to: UnitedHealthcare Vision ATTN: Claims Department P.O. Subscriber Information Please print clearly Subscriber Name Daytime Phone Evening Phone Mailing Address City State Name of Employer Zip Patient Information Patient Name Date of Birth Authorization Number Full Time Student Yes // No Verification may be required Claim Information Single Vision Lenses Bifocal Lenses Progressive Lenses Date of Service Exam Frame Is the provider an in-network provider Provider Name Contacts Contact Lens Fitting Exam Extra Ad-Ons Other Phone Number If you saw an in-network provider Are you applying for reimbursement after using an in-store sale or promotion you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. All rights reserved. All rights Reserved. Depending on your benefit coverage, a LASIK discount or allowance may be included. Main page content Document File(s) Superior Vison Claim Form. Box 30978 Salt Lake City, UT 84130 Fax: (248) 733-6060 Questions? Superior Vison Claim Form. If these technologies are not available, our page design helps ensure graceful degradation.
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