Claim Forms
Even if you have medical, vision, dental or prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network, there may be occasions when you have to pay for services yourself. For example, you have to see an out-of-network doctor that doesn’t accept your insurance.
You can use these claim forms to ask us for reimbursement. Just choose the form based on your group or health plan and the service. You’ll go to a page that explains the form and has a link to download it. Sometimes the form is called Member Application for Payment Consideration, which is the same as a claim form. If you were on a cruise, you'll use the same claim form for reimbursement of medical expenses.
If you have any questions, call the phone number on the back of your member ID card or contact us and we'll help.
If you paid for a COVID-19 test and think you might qualify for reimbursement, read the COVID-19 Testing Member Reimbursement Form (PDF) to find out more.
You may need to visit a doctor or hospital while traveling in another state. We have a nationwide network of providers that participate with Blue Cross Blue Shield of Michigan.
If you go to an out-of-state doctor or hospital that doesn’t participate with Blue Cross Blue Shield, you may pay upfront for health care services. To file a claim for those out-of-network services, you’ll need to use the claim form from the state where you were treated. Check the state-by-state list of Blue Cross Blue Shield companies to get started.
Because you’re insured through Blue Cross Blue Shield of Michigan, you have access to Blue Cross Blue Shield Global Core.
They have a claim form available you can use to ask for reimbursement for medical expenses you paid for while out of the country.
You'll need your subscriber ID card, formerly known as the enrollee ID, to log in to the site.
Follow these instructions to log in and get the International Claim Form:
Because you’re insured through Blue Cross Blue Shield of Michigan, you have access to Blue Cross Blue Shield Global Core.
If you have to pay for medical services while out of the country, they have a claim form available you can use to ask for reimbursement for medical expenses you paid for while out of the country.
You'll need your member ID card to log in to the site.
Follow these instructions to log in and get the International Claim Form:
Prescription drug reimbursement claim forms
Blue Care Network members prescription drug claim form
You can find medical and prescription drug claim forms on our Medicare website.
Because you’re insured through Blue Cross Blue Shield of Michigan, you have access to Blue Cross Blue Shield Global Core.
They have a claim form available you can use to ask for reimbursement for medical expenses you paid for while out of the country.
You'll need your subscriber ID card, formerly known as the enrollee ID, to log in to the site.
Follow these instructions to log in and get the International Claim Form:
Because you’re insured through Blue Cross Blue Shield of Michigan, you have access to Blue Cross Blue Shield Global Core.
If you have to pay for medical services while out of the country, they have a claim form available you can use to ask for reimbursement for medical expenses you paid for while out of the country.
You'll need your member ID card to log in to the site.
Follow these instructions to log in and get the International Claim Form:
Prescription drug reimbursement claim forms
Blue Care Network members prescription drug claim form
You can find medical and prescription drug claim forms on our Medicare website.