Office of the General Counsel Subrogation Department 232 S. Capitol Ave. L09A Lansing Michigan 48933-1504 517 325-4658 FAX No. 877 257-2012 E-mail SubrogationUnit bcbsm.com BCBSM SUBROGATION QUESTIONNAIRE FAX COMPLETED FORM TO 877-257-2012 or MAIL TO ADDRESS ABOVE Date Patient Name Date of Birth Contract 9 digit number on BCBSM card Spouse if on BCBSM policy BCBSM policy holder s name if different from the patient s name Your phone number Type of.
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the Bcbsmcomsubrogation Form online
Filling out the Bcbsmcomsubrogation Form is an important step in processing your claim. This guide will provide you with clear, step-by-step instructions to help you complete the form online efficiently and accurately.
Follow the steps to successfully complete the Bcbsmcomsubrogation Form.
- Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
- Enter the date at the top of the form to indicate when you are submitting it.
- Fill in the patient’s name. Ensure accuracy to avoid any delays in processing.
- Provide the patient’s date of birth in the designated field.
- Locate the contract number, which is a 9-digit number found on the BCBSM card, and enter it in the corresponding box.
- If applicable, provide the name of the spouse if they are on the BCBSM policy.
- Fill in the BCBSM policy holder's name if it differs from the patient's name.
- Input the date of birth of the policy holder in the appropriate field.
- Enter your phone number for contact purposes.
- Select the type of case from the options provided, such as personal injury or motor vehicle accident.
- Specify the state where the incident occurred.
- Indicate whether a vehicle was involved in the incident by selecting yes or no.
- If known, provide information about the court or workers' compensation bureau related to the case.
- Fill in the date of injury.
- Describe the type of injury and the area of the body that was affected.
- If you have hired an attorney, provide their name, law firm name, street address, city, phone number, state, zip code, and fax number.
- List the insurance company's name and the insurance adjuster's name.
- Enter the insurance claim number and the insurance company’s street address.
- Fill in the insurance adjuster's phone number and fax number.
- Provide the date and type of the next scheduled hearing date.
- After completing all fields, review the form for accuracy. Then, save your changes, download, print, or share the filled form as needed.
Complete your documents online today for efficient submission!
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
Jan 1, 2013 — The claim form is available from your BCBSM Service Center, the BlueCard...
The patient or his or her representative must sign a "Waiver of Benefits” form...
Consumer-driven healthcare (CDHC), or consumer-driven health plans (CDHP) refers to a type...
Get answers to your most pressing questions about US Legal Forms API.
Is Blue Cross Blue Shield the same as Blue Cross Blue Shield of Michigan?
Blue Cross Blue Shield operates as a federation of independent companies, which includes Blue Cross Blue Shield of Michigan, but they are not identical. Each state has its own separate organization under the overall Blue Cross Blue Shield umbrella. This distinction allows for tailored services, including the subrogation process, which may involve filling out the Bcbsmcomsubrogation Form. For members, understanding these differences can enhance their experience with their specific local plans.
What is the address for the Blue Cross Blue Shield of Michigan?
The headquarters for Blue Cross Blue Shield of Michigan is located at 600 Lafayette Blvd, Detroit, MI 48226. If you wish to reach out regarding subrogation matters, utilizing their official communication channels is recommended. You may need to reference the Bcbsmcomsubrogation Form to facilitate any inquiries related to claims or recovery processes. This form serves as a helpful tool in navigating your interactions.
Who handles subrogation for Blue Cross Blue Shield of North Carolina?
The subrogation process for Blue Cross Blue Shield of North Carolina is managed by a specialized team focused on recovering costs after a member receives benefits. This team assesses each case carefully to ensure fairness and efficiency. If you need to fill out the Bcbsmcomsubrogation Form for your case, the team will guide you through the necessary steps. Engaging with their support can streamline your experience.
What is the address for Blue Cross Blue Shield of Michigan?
The address for Blue Cross Blue Shield of Michigan is 600 Lafayette East, Detroit, MI 48226. This location serves as the central office for various member services. Be sure to check their official website for the most recent updates regarding their services. If you are dealing with the Bcbsmcomsubrogation Form, having the correct information is essential.
Who issues the letter of subrogation?
Subrogation letters are typically sent by insurance companies after they have paid out a claim to their insured for damages or losses caused by a third party.
How do insurance companies handle subrogation?
Subrogation allows your insurer to recoup costs (medical payments, repairs, etc.), including your deductible, from the at-fault driver's insurance company, if the accident wasn't your fault. A successful subrogation means a refund for you and your insurer.
What is the subrogation law in Michigan?
Subrogation is the substitution of one person into the place of another with respect to rights, claims, or securities. Medicaid subrogates when a Medicaid recipient has been injured and someone other than the person or party at fault pays for all or some of the damages resulting from the injury.
Can I ignore a subrogation letter?
You have no legal obligations to respond to a subrogation letter. You can put the letter in the garbage and ignore additional notices, but it's not in your best interest. Immediately dealing with a subrogation letter allows you to resolve a claim sooner than later.
What is the legal right of subrogation?
Subrogation means, in a legal sense, one party has the right to "step into the shoes" of another party to bring a claim for damages. Not all types of claims may be subrogated. The most common type that can be subrogated is property damage claims.
Is subrogation allowed in Michigan?
No, there cannot be subrogation for the non-economic damages that are awarded to the claimant. Only the economic damages can be subrogated to the rights of the insurer. Even so, the insurer cannot claim all of the awards if some other medical liens or parties filed for the recovery of expenses relating to the accident.
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.