Blue Care Network Member Billing Form

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you're a Blue Care Network member, use this form to send us a bill that you feel you shouldn't have to pay for.

If you get a bill from a doctor or hospital you feel you shouldn’t have to pay, use this form to send us the bill.

If you already paid the bill, use the Blue Care Network member reimbursement form to ask for reimbursement.

If you have any questions, call the phone number on the back of your enrollee ID card and we’ll help.

What you’ll need:

  • Your enrollee ID card
  • A printer to print the form
  • Original receipts for the services you received
  • A copier or scanner to make a copy of each receipt for yourself
  • An envelope and postage to mail the form

Blue Care Network Member Billing Form (PDF)

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