Did you know coverage decisions are a regular part of getting medical care?
That's because your plan makes a coverage decision every time it decides what's covered and how much it pays.
They're also a regular part of getting a prescription, except we call them coverage determinations.
Sometimes, you or your doctor will need to check with your plan to see if something is covered before you get it.
In most cases your doctor will contact us. You or someone other than your doctor acting on your behalf—a representative—can also ask for a coverage decision.
If a representative will be doing it for you, make sure you fill out and send us an Appointment of Representative form. We won’t be able to make our decision without it.
It depends on what you’re asking us about.
We can give you what’s called a fast decision if:
In these cases, we’ll reply within 72 hours if it’s related to a medical service, and 24 hours if it’s related to a prescription drug. It’s best to have your doctor or pharmacist request a fast coverage decision.
If your doctor doesn’t do it for you, the best way to start is by calling the number on the back of your member ID card.
You can also write us, send a fax or fill out a form.
Don't have your Blue Cross ID card handy?
Here's another way to reach us by phone.
1-877-241-2583
TTY users call 711
8 a.m. to 8 p.m. ET
Monday through Friday
Ask your doctor to write down a description of the service, why you need it and any other information. Then mail or fax to:
Blue Cross Blue Shield of Michigan
Pharmacy Help Desk
P.O. Box 807
Southfield, MI 48037
Fax: 1-877-348-2251
Don't have your Blue Cross ID card handy?
Here's another way to reach us by phone.
1-800-450-3680
TTY users call 711
8 a.m. to 8 p.m. ET
Monday through Friday
Ask your doctor to write down a description of the service, why you need it and any other information. Then mail or fax to:
BCN Advantage
Pharmacy Help Desk
P.O. Box 807
Southfield, MI 48037
Fax: 1-888-458-0716
Coverage decisions for prescription drugs are also called coverage determinations. You can request a coverage determination when:
You can find information about drug tiers, step therapy, prior authorization and more by looking in your plan's drug list.
If you want to talk to us about a coverage determination, start by calling the number on the back of your member ID card or fill out our online prescription drug coverage determination form.
You can also write us a letter, send a fax or submit a form.
Don't have your Blue Cross ID card handy?
Here's another way to reach us by phone.
1-877-241-2583
TTY users call 711
8 a.m. to 8 p.m. ET
Monday through Friday
You can ask us to change how we cover a prescription drug using the Medicare Plus Blue PPO and Prescription Blue PDP Request for Determination Form (PDF).
Blue Cross Blue Shield of Michigan
Clinical Pharmacy Help Desk — TC1308
P.O. Box 807
Southfield, MI 48037
Fax: 1-866-601-4428
Don't have your Blue Cross ID card handy?
Here's another way to reach us by phone.
1-800-450-3680
TTY users call 711
8 a.m. to 8 p.m. ET
Monday through Friday
You can ask us to change how we cover a prescription drug using the BCN Advantage HMO and HMO-POS Request for Determination Form (PDF).
BCN Advantage
Clinical Pharmacy Help Desk — MC TC1308
P.O. Box 807
Southfield, MI 48037
Fax: 1-800-459-8027