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VSP MEMBER REIMBURSEMENT FORM . To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. Be sure to keep a copy for your records. VSP . PO Box 385018 . Birmingham, AL 35238-5018 . PATIENT Relation to Member*: (choose one)
VSP MEMBER REIMBURSEMENT FORM To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. Be sure to keep a copy for your records. VSP PO Box 495918 Cincinnati, OH 45249-5918. PATIENT Relation to Member*: (choose one)
Out-Of-Network Reimbursement Form Coordination of Benefits Information: If you are coordinating benefits with another insurance carrier, we need a complete copy of the Explanation of Benefits from your primary insurance carrier. ... VSP.com. Title: VSP reimburse.doc Author: asanfor Created Date: 6/28/2004 10:01:02 AM ...
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VSP Member Reimbursement Form . To request reimbursement, complete this form (in blue or black ink), enclose a legible copy of your itemized receipt(s), and send . them to the following address. Be sure to keep a copy for your records. VSP PO Box 385018 Birmingham , AL 35238 -5018 Ref # ...
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VSP MEMBER REIMBURSEMENT FORM. To request reimbursement, complete and print this form, enclose a legible copy of your itemized receipt(s), and send them to the following address. Be sure to keep a copy for your records. VSP PO Box 495918 Cincinnati, OH 45249-5918. Relation to Member*: (choose one)
