Out-of-Network Claims

Submit an out-of-network claim if you have seen an out-of-network provider or utilized an in-store sale or promotion from an in-network provider. If you choose to use an out-of-network provider or utilize an in-store sale or promotion from an in-network provider, pay the provider in full for the services and eyewear received at the time of your appointment.

Click here to download the
Out-of-Network Claim Form

Complete the claim form and attach a copy of your receipt or itemized bill that explains what services were provided.

Mail or fax these to:

Physicians Eyecare Plan
Attention: Claims Department
48 Courtenay Dr
Charleston, SC 29403

Fax: (843) 577-5895

You will be reimbursed the following amounts:
Exam including contact lens fitting: $40
Materials: 65% of the material allowance that was used, less material copay

Reimbursement claims must be received within six months from the date of service. You will receive a reimbursement check approximately 6 weeks after your claim was submitted to Physicians Eyecare Plan.

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