Browse by Topic

Browse by Plan Type

Other Help

Not finding what you need in this section for members and insurance shoppers? Check out our other help sections below.

What is a claim?

Who is this for?

Michigan Health Insurance - Customer Service - What is a claim?

If you go to a doctor that's not in your network, you'll need to know the process of getting reimbursed for the services you received.

Simply put, a claim is a request to be paid for a health care service.

When you visit your doctor for a check-up, your doctor submits a claim to your insurance company. Your insurance company reviews the claim, approves the claim and then pays your doctor.

What you need to do

Normally, your health care professionals will take care of your claims. However, if you visit a doctor outside of your network, you may have to submit the claim yourself.

In those situations, you'll pay the full cost of the service. Then you'll submit a claim to us. We’ll reimburse you for the portion covered by your health care plan when we approve your claim.

You'll need separate claims for each type of service you want to be reimbursed for. Let's say you get sick and you decide to visit an out-of-network doctor. The doctor examines you and gives you two prescriptions. You pay the full cost of the doctor's visit before you leave. Then, you go to the pharmacy. You pay the full cost again when you pick up your prescriptions.

When you get home, you'll need to fill out two claims: one for the doctor's visit and one for the prescriptions. It's okay to have multiple prescriptions on the same claim because they came from the same pharmacy.

What is Master Medical?

Master Medical is a plan that helps you pay for the services your basic health care plan doesn't cover. You can add it to the Blue Traditional coverage you get through your employer.

Related Items

Was this content helpful?

Rate it

Submit >

One site. One stop.

Managing your health plan online
has never been easier. On the new bcbsm.com, all your account information is in one place and personalized, so it's more useful.
Even better, you can access it anytime, anywhere, from your mobile device.

I’d like to register

Log in to my account

©1996-2014 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information

Explanation of Level A Conformance
Better Business Bureau Online Seal of Reliability