Metabolic Diseases and Foods Claim Form

If you’re insured through Blue Cross Blue Shield of Michigan, you can use this form to ask for reimbursement for medical expenses related to metabolic diseases and foods.

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

What you’ll need:

• Your subscriber ID card
• A printer to print the form
• Original receipts from your doctor, dentist, etc.
• A copier or scanner to make a copy of each receipt for yourself
• An envelope and postage to mail the form

Member Application for Payment Consideration for Metabolic Diseases and Foods (PDF)