How do I submit a claim?

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Michigan Health Insurance - Customer Service - How to submit a claim?

If you paid for your visit when you went to the doctor, 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. 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 your doctor.

If you visit a non-participating doctor, you may have to pay the full cost for the service upfront 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 claims 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 claims forms to find the one you need.

Tip: Your Blues ID card can help you when you're filling out forms. Keep it handy.

2. Attach the original copies of your receipts to the claims 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 claims 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.

Tip: If you're handling the claims for your family, you'll need to fill out separate forms for each family member.

3. Mail the claim and receipts to the address on the form.

Tip: You may want to make copies of your receipts for your records in case you have an issue with your claim.

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 claims 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.

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