Usually, we pay your health care providers for you without you having to do anything. But, sometimes you have to pay the doctor or hospital yourself. This form is how you ask us to reimburse you.
You can use the Member Application for Payment Consideration form to ask us for reimbursement for dental claims you have paid for yourself.
Use this form to ask for reimbursement for medical expenses related to metabolic diseases and foods.
If you have a problem with your Blue Cross Blue Shield of Michigan service, you can use this form to file an appeal with us.
Some employers can object to contraceptive coverage, but the Affordable Care Act says you can ask us to make an exception for you. Use this form to request contraceptive accommodation.
If you have to pay a provider or hospital for services, this form is how you ask us to reimburse you.
This form is for bills you receive from providers who don't participate with us. Use it to send us a bill that you haven’t paid.
Use these forms if you've paid up front for prescription drugs that your insurance covers and you'd like to be reimbursed.
Do you have questions about Blue Cross Blue Shield of Michigan claims? Learn how to submit a claim, check on a claim, and more.
Use this form to enroll a subscriber in a new plan or make changes to an existing plan, such as adding or removing a dependent.
Use this if you have a Blue Cross Blue Shield of Michigan plan other than Healthy Blue Achieve that requires a qualification form.
If you have our Healthy Blue Achieve plan, this qualification form is for you. To get your financial incentive, you'll need to fill it out with your doctor.
If you're a Blue Care Network member, use this form to select or change your doctor.
Learn about managing your Blue Cross Blue Shield of Michigan account, such as paying your premium, changing your health coverage and much more.
This application may be used for 2023 individual and family coverage through either Blue Cross Blue Shield of Michigan or Blue Care Network.
This application may be used for 2024 individual and family coverage through either Blue Cross Blue Shield of Michigan or Blue Care Network.
A summary of benefits and coverage from Blue Cross Blue Shield of Michigan or Blue Care Network explains things like what your health plan covers, what it doesn't cover, and what your share of costs will be.
Use the Optum prescription drug mail order form to get your prescription drugs by mail.
Specialty drugs are prescription medications that require special handling, administration or monitoring.
Is your medication covered by your Blue Cross Blue Shield of Michigan health plan? Click on the helpful drug list links to find out.
Learn more about your Blue Cross Blue Shield of Michigan pharmacy benefits, including whether your prescribed drug is covered.