How do I submit a claim?
Who is this for?
If you paid for a health care service and you think your plan covers that service, here's how to get reimbursed.
How it works
A claim is a payment request for a health care service, such as a visit to your doctor, hospital or dentist, or if you buy prescription drugs. When you visit your doctor for a check-up, your doctor submits a claim to us to pay for the service. Once we receive the claim, we'll review your plan and determine if we cover the service. If we approve the claim, we'll pay for the health care service.
You have up to a year from the date of service to submit a medical or pharmacy claim. And you have two years from the date of service to submit a dental claim.
Although it doesn’t happen very often, it's possible we'll deny your claim even after you've had treatment. There are some things you can do to help minimize the risk of it happening to you. Be sure to follow these steps:
- Pay your premium on time
- Show your Blue Cross ID card whenever you get health care services
- Notify us of any changes to your coverage, including any other insurance you have
- Get any required authorization before you get health care services
If you visit a non-participating doctor, you may have to pay the full cost for the service up front and then submit a claim to us yourself. Once we approve your claim, we’ll reimburse you for the part we cover, based on your plan.
If you get a prescription filled at a non-participating pharmacy and you pay for it yourself, you can submit a claim for reimbursement. If you get more than one prescription filled at the pharmacy, you can put them on the same prescription claim.
Submitting a claim
We want to make it as easy as possible for you to submit your claims. Here are the steps.
1. Fill out the appropriate claim form. The form you need depends on your plan and the service you want to be reimbursed for. Forms can vary depending on the type of care you received. If you get health care through the government, you’ll fill out a different form. Please visit our list of claim forms to find the one you need.
2. Attach the original copies of your receipts to the claim form. The receipts should include an itemized list of the services you want us to reimburse you for. We can’t accept cash register receipts, canceled checks or money order stubs.
What do my receipts need to have on them?
To help us process your claim, please be sure that your receipts and claim forms include:
- The enrollee's name
- Your health insurance contract number
- The patient's name
- The service date
- Your health care professional's name
- Your health care professional's address
- Your health care professional's tax identification number
- A description of the service performed (HCPCS or procedure code)
- The diagnosis
- The service cost (itemize the charges if there's more than one service on a receipt)
Take a look at some sample receipts to help you understand the information you should include.
3. Mail the claim and receipts to the address on the form.
What if I'm outside the U.S.?
If you receive health care services outside the U.S., you'll have to pay for the service yourself. Then, you'll need to fill out an international claim form for reimbursement and send it to us. When you're outside the U.S., most plans will only cover emergency services, not standard care.
Find out more about the form and how to fill it out at the Blue Cross Blue Shield Association's website in the section about the BlueCard® Worldwide program.
How long do I have to submit my claim?
The time limit you have to submit your claim depends on what kind of plan you have. If you have a PPO or EPO plan with Blue Cross Blue Shield of Michigan, you have 24 months from the date of service to submit a claim. If you have an HMO plan with Blue Care Network, you have 12 months.
These timeframes don’t reflect any government mandated rules. If you have a Medicaid plan, for instance, you’ll have three years to submit a claim.