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Out-of-Network Reimbursement

If your plan offers out-of-network coverage and you were eligible for benefits on the date of service, you may submit a claim to VBA for reimbursement.

Getting Started

Confirm eligibility for out-of-network benefits by accessing the Member Information tab in VBA’s member login, or by contacting us.

What You’ll Need

To submit a claim, you will need to provide us with a copy of your itemized receipts or service statements with the following information:

  • Provider’s name
  • Patient’s name
  • Date of service
  • Services and/or materials received
  • Amounts paid

Once you have collected the above documents, use the information to complete VBA’s Out-of-Network Reimbursement Form.

View Form (Click Here for Spanish version)

Submit via Mail or Fax:

After completing and signing the Out-of-Network Reimbursement Form, you may mail or fax your claim with copies of your itemized receipts to:

400 Lydia Street, Suite 300

Carnegie, PA 15106
  412-881-4898 (Facsimile)



Go green! For faster processing, you can now submit your claim to VBA electronically. Simply use VBA’s member login with the policy holder’s information, and select “Out-of-Network Claims.” From there, follow the prompts to upload images of your signed forms and receipts.

Processing Your Claim
Please allow up to 15 business days (after receipt) for VBA to process your reimbursement claim.