How Do I Submit a Claim for a Payment I Made at the Doctor, Pharmacy or Dentist?

When you go to the doctor or dentist who takes your insurance, you usually don’t have to do much at checkout.

That’s because the office and your plan handle the paperwork.

  • The health care provider sends us a claim for their services.
  • We figure out what your plan covers and how much.
  • We send the provider payment for charges your plan covers.
  • You get a bill later from the provider for amounts your plan doesn’t cover.

But some health care providers don’t submit claims to us. They may collect payment from you in full at the time the service or prescription is provided.

This can happen when you:

  • Go to a doctor, dentist, pharmacy or other provider who doesn’t take your insurance
  • Need care while traveling outside of the U.S.

In these cases, you’ll have to send us the claim yourself.

How to submit a claim

You’ll need to fill out a claim form and mail it to us. Then we can figure out what your plan covers and how much. We’ll reimburse you for charges your plan should pay.

For medical and dental services you got in the U.S., Puerto Rico or the U.S. Virgin Islands, use these claim forms.

For medical care you got anywhere else, including on a cruise ship outside U.S. waters, use the Blue Cross Blue Shield Global Core international claim forms. You’ll need your Blue Cross ID card to log in to the site.

For prescriptions you got inside or outside the U.S. or U.S. territories, use these claim forms.

How long you have to submit a claim form

These deadlines apply to members submitting their own claims.

  • For medical claims under all plans, the deadline to submit is two years from the date of service.
  • For pharmacy claims under all plans, the deadline to submit is one year from date of service or as required by your plan.
  • For Blue Dental℠ claims, the deadline to submit is two years from the date of service.

Checking the status of a claim

The best way to get information about claims is to log in to your member account. You can do that using our website or the Blue Cross Blue Shield of Michigan app.

Keep in mind that due to requirements for protected health information, not everyone on a plan may be able to see all claims. For example, adults on a plan can’t see the claims of other adults.

Look under the member icon dropdown menu in the upper right corner of our website — My Account on the app — to learn about and to change permissions that affect who sees your claims.

You can also check claim status by phone. During business hours, you can talk with a representative. Or you can check the status of a claim anytime using our automated system. Just call the number on the back of your Blue Cross ID card.

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