Report fraud online

Information submitted in this form is neither secure nor encrypted.

Please include your contact information if you would like a response.

You may remain anonymous. All information we receive is strictly confidential.

Please fill in as much information as possible.

Your information refers to you, the person reporting the fraud. As noted in the form, completing this section is optional if you wish to remain anonymous.
Insured's information refers to the person who carries the insurance.

Your information (optional - you may remain anonymous):

First Name

Last Name

Street Address

City

ZIP Code

Email Address

Phone Number

Evening Phone Number

Insured's information (person who carries the insurance):

First Name

Last Name

Subscriber ID, formerly enrollee ID This number may be found on your Blue Cross Blue Shield of Michigan or Blue Care Network enrollee ID card or any Explanation of Benefits statement.

Street Address

City

ZIP Code

Phone Number

Person or company your complaint is about:

Name

Street Address

City

ZIP Code

Phone Number

Identifying Characteristics

Race

Male Female

Weight

Height

Known Associates

Date of Incident(s) mm/dd/yyyy

Summary of Complaint

Type the above number: