If you saw an eye doctor who is not in the Davis Vision network and paid out of pocket, the Davis Vision reimbursement form is how you ask the plan to pay you back. It is officially called the Direct Reimbursement Claim Form, and the idea is the same whether you needed an eye exam, glasses, or contacts from a provider outside the network.
The process is not complicated, but it is easy to lose money to small mistakes: a missing signature, the wrong mailing address, or claiming a service the form does not cover. Davis Vision also reimburses out-of-network visits at a set allowance that is usually lower than the in-network value, so understanding how the form works before you file helps you get back as much as the plan allows.
This guide walks through exactly what the form is, when you need it, what you can claim, how to fill it out, where to send it, and how long reimbursement takes. Davis Vision is a Versant Health company, and while the core process is the same across plans, a few details like the exact phone number and mailing address can vary by the employer or group that sponsors your benefits, so always check the numbers printed on your own form and ID card.
If you run an eye care practice, this same form sits at the end of a decision your front desk makes at check-in, and there is a section below on how to keep patients from needing it at all. If the claim already went out and came back, see the Davis Vision timely filing limit, because the sixty day clock started at the exam.
What is the Davis Vision reimbursement form?
The Davis Vision reimbursement form, officially the Direct Reimbursement Claim Form (sometimes labeled the Out-of-Network Reimbursement Claim Form), is the document you use to request money back for eye care you received from a provider who does not participate in the Davis Vision network. In network, the provider bills Davis Vision directly and you never touch a claim form. Out of network, you pay the provider in full at the time of service and then submit this form to be reimbursed at your plan's out-of-network allowance. Both the exam and the eyewear can go on the same form, and only the services printed on the form will be considered.
KEY TAKEAWAY
The reimbursement form is only for out-of-network care. If your provider is in the Davis Vision network, they file for you and you do not need this form at all.
When do you actually need it?
You need the form only when you go out of network, and two things are worth checking first. Confirm the provider really is out of network, because if they participate you can avoid the form and most of the out-of-pocket cost entirely. Then know that on most Davis Vision plans the benefit cannot be split within a single benefit period: you either use in-network (prepaid) services or the direct reimbursement option, not both. If you already used part of your benefit in network, the reimbursement path may not be available until your benefit renews.
⚠ WARNING
Using an out-of-network provider usually means paying the full cost upfront and getting back only the plan's allowance, which is typically less than the in-network value of the same benefit.
KEY TAKEAWAY
Out-of-network reimbursement is a fallback, not a discount. Check that the provider is truly out of network and that you have not already used the benefit in network this period.
What you can claim on the form
The form covers both parts of a routine vision visit: the eye examination and the eyewear. That includes frames, single-vision, bifocal and trifocal lenses, and contact lenses, including medically necessary contacts on some plans. You list each service, the date it was performed, and the amount you paid. Only the services listed on the form are considered, so anything you leave off will not be reimbursed. If you are claiming for more than one family member, each patient needs their own separate form.
📊 KEY STAT
One form, one patient. Davis Vision asks you to submit a separate claim form for each person, even if the whole family was seen on the same day.
KEY TAKEAWAY
List every service and its cost on the form. The exam and eyewear can share one form, but each family member needs a form of their own.
How to fill out and submit the Davis Vision claim form
Filling out the Direct Reimbursement Claim Form is mostly about being complete and accurate. Work through it in this order:
First, get the correct form. Download it from the member portal at davisvision.com or from your employer's benefits page. Next, enter your member information, including your name and Member Identification Number, which is the ID your plan sponsor uses to identify you and appears on your card. Then add the patient information and the patient's relationship to you. List each service, its date of service, and the amount you paid. Sign the form, because the member's signature is always required. If the provider did not sign it, you can usually submit an itemized receipt in place of the provider's signature. Attach that itemized receipt, and make a copy of everything for your records before you send it.
💡 INSIGHT
An incomplete form is the most common reason reimbursement is delayed. A missing signature, a blank date of service, or no itemized receipt sends the claim back and restarts the clock.
KEY TAKEAWAY
Complete every section, sign it, and attach an itemized receipt. A receipt can usually stand in for the provider's signature, but your own signature is never optional.
Where to send it, and can you submit online?
Most Davis Vision out-of-network claims are mailed to the Vision Care Processing Unit, P.O. Box 1525, Latham, NY 12110. Some plans route to a different processing address, such as P.O. Box 479, Troy, NY 12181, so the address printed on your own form is the one to trust. Some plans also let you submit the claim online through the member portal at davisvision.com once you log in. That option depends on your group, so if you do not see a claims feature online, mail the form instead. To confirm your coverage or the right submission method before you file, call the member services number on your ID card. The general Davis Vision member line is 1-800-999-5431, though employer groups sometimes print a different number on their forms.
✅ READ MORE
Not sure whether your visit should have been billed to your vision plan or your medical insurance? See GIMBL's guide to verifying patient insurance benefits.
KEY TAKEAWAY
Mail to the address on your form, commonly P.O. Box 1525, Latham, NY 12110, or submit online through the member portal if your plan offers it. When in doubt, call the number on your ID card first.
How much you get back, and how long it takes
Out-of-network reimbursement is paid at your plan's out-of-network allowance, a fixed schedule of amounts for the exam and each type of eyewear. That allowance is usually lower than the value of the same benefit in network, so expect to be reimbursed for part of what you paid rather than the full amount. Once Davis Vision receives a complete form, reimbursement typically takes a few weeks, and many members see payment in about two to three weeks. Incomplete forms take longer. Submitting the form does not guarantee eligibility, which is why it helps to verify your coverage before the visit rather than after.
KEY TAKEAWAY
Expect the plan's allowance, not a full refund, and roughly two to three weeks for a complete claim. Verifying eligibility before the visit is the best way to avoid a surprise.
For eye care practices: help patients avoid the form entirely
If you run an optometry practice, this form is what a patient reaches for after a visit went out of network or the wrong plan was billed. From the practice side, most of that is decided at check-in. Confirming whether the provider is in the Davis Vision network, whether the visit is routine (vision plan) or medical (medical carrier), and which plan should be billed all happen before the claim exists. When that routing decision is right, the practice bills in network, the patient never pays out of pocket, and no reimbursement form is ever needed. When it is wrong, the patient is left chasing a partial refund by mail.
✅ READ MORE A misrouted claim also burns the filing window. See**** the Davis Vision timely filing limit and what starts the clock.
The cleanest reimbursement is the one nobody has to file, and that comes from getting the eligibility and routing decision correct up front.
💡 INSIGHT
In eye care, the same visit can belong to a vision plan or a medical carrier. Verifying both before the exam is what decides whether a patient walks out covered or walks out with a claim form.
▶ FOR PRACTICES
Run a practice and want visits routed to the right payer before the claim exists? See how GIMBL works and start your pilot.
✅ READ MORE
For the full workflow, see GIMBL's complete optometry billing guide.
KEY TAKEAWAY
Whether a patient needs a reimbursement form is set at check-in. Correct in-network and medical-versus-vision routing means the practice bills cleanly and the patient never files.
Frequently asked questions
How do I file a claim with Davis Vision?
Download the Direct Reimbursement Claim Form, complete every section, list each service with its date and cost, sign it, and attach an itemized receipt. Then mail it to the address on the form, commonly the Vision Care Processing Unit, P.O. Box 1525, Latham, NY 12110, or submit it online through the member portal if your plan allows.
Can I submit my Davis Vision reimbursement online?
Some plans let you submit through the member portal at davisvision.com after you log in. Availability depends on your group. If there is no online claims option for your plan, mail the completed form instead.
What is the Davis Vision claims mailing address?
Most out-of-network claims go to the Vision Care Processing Unit, P.O. Box 1525, Latham, NY 12110. Some plans use a different address, such as P.O. Box 479, Troy, NY 12181, so always use the address printed on your own form.
How long does Davis Vision reimbursement take?
For a complete claim, usually about two to three weeks. Missing signatures, dates, or receipts are the main reasons a claim takes longer.
How much does Davis Vision reimburse for out-of-network care?
At the plan's out-of-network allowance, a set amount per service that is usually lower than the in-network benefit. Expect partial reimbursement rather than a full refund of what you paid.