Kids X-Small [Ages 5-7]
Kids Small [Ages 6-9]
Kids Medium [Ages 9-14]
Kids Large [Ages 12-17]
Kids X-Large [Ages 14-18]
Adult Narrow
Adult Average
Adult Wide

United Healthcare

Follow these easy steps to submit an out-of-network claim for reimbursement through United Healthcare. Every plan is a little different, so be sure to contact United Healthcare directly for details on your out-of-network benefits and eligibility.

1. Obtain a copy of your itemized receipt.
Contact us with your Subscriber ID, and the Name and DOB of the patient. We'll provide you with an itemized receipt for your order that includes these extra details.

2. Start your claim.
Download and complete the form for your claim at

3. Submit your claim.
Fax both items to (248) 733-6060 or mail both items to:

United Healthcare Vision
Attn: Claims
PO Box 30978
Salt Lake City, UT 84130

4. Questions about your claim?
For help submitting your claim, or to check the status of your reimbursement, log in to your UHC Vision account or call Customer Service at (866) 760-1274.