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Claim Forms
Who is this for?
If you recently visited a doctor outside of your network and you need to submit a claim, you can use one of these claim forms.
Even if you have medical, vision, dental or prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, there may be occasions when you have to pay for services yourself. For example, you have to see an out-of-network doctor that doesn’t accept your insurance.
You can use these claim forms to ask us for reimbursement. Just choose the form based on your group or plan and the service. You’ll go to a page that explains the form and has a link to download it. Sometimes the form is called Member Application for Payment Consideration, which is the same as a claim form.
If you have any questions, call the phone number on the back of your enrollee ID card or contact us and we'll help.
Medicare member?
You can find medical and prescription drug claim forms on our Medicare website.
Need to submit a Master Medical claim?
You'll find helpful instructions and the form you need in this article: "How to submit a Master Medical claim."
Traveling outside of the U.S.?
Because you’re insured through Blue Cross Blue Shield of Michigan, you have access to the BlueCard Worldwide® Program.
If you have to pay for medical services while out of the country, they have a claim form available you can use to ask for reimbursement for medical expenses you paid for while out of the country.
You’ll need your enrollee ID card to log in to the site. Just click Claim Forms and Brochures in the left hand column. Then select International Claim Form.
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