PVS - Preferred Vision Service


	INSTRUCTIONS AND SUGGESTIONS FOR PVS MEMBERS Request a Vision Claim Form by calling directly at (248)524-9581 or by filling out a Vision Request Card and mailing or faxing to (248)524-9429. Please request a claim form before making your appointment. It can only be used by the person whose name is printed at the top of the form. Claim forms are only valid for 60 days If a date appears in one of the boxes marked “Examination”, “Lenses”, or “Frames”, you will not be eligible for that benefit until the date shown. Select a Provider from the PVS Doctors list, make an appointment, and give the form to the Provider on your first visit. Sign the vision claim form after the examination and/or after you have selected any necessary materials. If there are additional charges, please make sure that they are listed on the claim form and that you understand them, before you sign the form. Request for a copy of the claim form for your records. Providing Doctors should not be balance billing. If you receive a bill that you do not understand, please let PVS know as soon as possible. If you receive services from a doctor not on the Provider List, you will need to submit a copy of a detailed paid receipt, along with your claim for to obtain a scheduled reimbursement. If you have any questions, or feel that you have been overcharged, please feel free to call (248)524-9581.

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