Claims Information and Appeals

  • In-network providers file claims with Premera on your behalf. If you receive care from an out-of-network provider, you may have to pay the provider directly and file a claim for reimbursement.

    To file a claim

    1. Complete and sign a Member Submitted Claim Form or a Pharmacy Claim Form.
    2. Attach the itemized bill from the provider for the covered service.
    3. Make a copy for your records.
    4. Mail your claim to the address shown on the claim form.

    Please see your benefit booklet for more details on filing claims.

    Appeals process

    You can request a review if you disagree with how a claim was paid as it is described on your explanation of benefits (EOB). Premera Blue Cross must receive your request to review a claim within 180 days after you receive your EOB. You can either call Customer Service at 877-224-3525 or complete and submit a Member Appeal Form. You can also use this form to authorize another party to submit an appeal on your behalf. If you suspect fraud in the processing of your claim, such as payments that were made for services you didn't receive, please call the Anti-Fraud Hotline at 800-848-0244.

    Consumer Choice Plan Appeals Process

    PPO Plan Appeals Process