Blue Cross Blue Shield of Michigan General Member Claim Form

Even when you have health insurance, there may be occasions when you have to pay for services yourself. For example, you have to see an out-of-network doctor who doesn’t accept your insurance.

You can use this form to ask us for reimbursement for medical and hearing services. You’ll need to use separate forms for dental claims, prescription drug claims and contraceptive prescriptions or services claims.

For vision reimbursement claims, Heritage and VSP have their own claim forms and processes. Check the back of your Blue Cross ID card to determine which plan you have.

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

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