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  • Your information refers to you, the person reporting the fraud. As noted in the form, completing this section is optional if you wish to remain anonymous.
  • Insured's information refers to the person who carries the insurance.
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Insured's information (person who carries the insurance):
This number may be found on your Blue Cross Blue Shield of Michigan or Blue Care Network enrollee ID card or any Explanation of Benefits statement.
Person or company your complaint is about:

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Summary of Complaint

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