Need Help?

We're here to answer your questions.

Claim Forms

Who is this for?

Medicare Help Center | Forms | Claims Forms

If you paid out-of-pocket for services you think we should cover, use one of these forms to submit a claim to us.

When you go to a doctor or pharmacy outside your plan's network, you might have to pay for the visit or drug in full up front. But if you think we cover the service, you can ask us to reimburse you for what we owe. You'll just need to fill out one of these claim forms.

Choose your health plan below to find the form and instructions for sending it in.

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

What you'll need:

  • Your Blues ID card
  • Original receipts from your doctor, pharmacy, etc.

Was this content helpful?

Rate it

Submit >

©1996-2014 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 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  |  Important Information About Medicare Plans

Y0074_W_Jul14WebBCBSBCN Pending CMS Approval

Page Last Updated Mon Jul 07 16:32:48 EDT 2014