• Blue Cross® Partnered, Select or Preferred (Catastrophic, Bronze, Silver or Gold)
  • Blue Cross® Metro Detroit HMO

Use this form: Authorization Agreement for Automatic Payments Form (PDF)

Mail the form to:

Blue Care Network
IAA/Billing Department — Mail Code C415
P.O. Box 5043
Southfield, MI 48086-5043

Fax: 1-866-615-6793