Blue Care Network Member Billing Form

If you get a bill from a doctor or hospital you feel you shouldn’t have to pay, use this form to send us the bill.

If you already paid the bill, use the Blue Care Network member reimbursement form to ask for reimbursement.

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

What you’ll need:

  • Your enrollee ID card
  • A printer to print the form
  • Original receipts from your doctor, dentist, etc.
  • A copier or scanner to make a copy of each receipt for yourself
  • An envelope and postage to mail the form

Blue Care Network Member Billing Form (PDF)