Indiana Optometric Association

Third Party Issues

Please fill out this form if you are having a claims issue with a third party payor. It will be forwarded to the third party committee, and they will get back to you as soon as possible. Thank you!

ANTITRUST COMPLIANCE REMINDER STATEMENT:
The antitrust laws are designed to prevent colluding (or appearing to collude) on practices that affect prices, fees, or the ability of others to compete. The Indiana Optometric Association (IOA) hereby notifies all persons entering information on this website that they shall refrain from actions that could have anti-competitive effects. In providing information or requesting assistance, your inquiry must avoid discussions of prices you pay or the prices you charge for goods and services, discounts offered of any nature, quality ratings of 3rd party payers, allocation of territories, refusal to deal with a third party, or agreements to "lock out" a third party. Should your inquiry be deemed to potentially violate any antitrust law, we will be unable to respond. Responses provided by the 3rd Party Committee or the IOA are for informational purposes only, and should not be construed as legal advice.

First Name *

Last Name *

Email *

Address (Street and City) of Your Practice:

Phone Number:

Are you a member of the Indiana Optometric Association? *

Yes

Name of Insurance Carrier:

What is the nature of your issue?

Is this an...
Choose 1

Is this an issue with...
Choose up to 3

Medicare

Medicaid

Commercial Insurance

Is this claim for...
Choose up to 2

Vision Care

Medical Eye Care

Are you in or out of network for this carrier?
Choose 1

Can you provide a redacted copy of the claim filed and the EOB ? *

Yes

If yes, please provide here.

If this was a denied claim, what was the reason for denial?

What steps have been taken to resolve this issue?