Claims Information and Appeals

  • Almost always, in-network and BlueCard® PPO network providers will file claims for you. However, if you receive care from a provider outside of the BlueCard network you may have to pay the provider for the service and file a claim for reimbursement.

    To File a Claim

    1. Complete and sign a Medical 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 800-995-2420 or submit a written request. 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.

    To submit a written request for appeal, write to:

    Premera Blue Cross
    ATTN: Claims Appeals
    P.O. Box 91102
    Seattle, WA 98111-9202

    Appeals Process