Bcbsm Subrogation PDF Details

Michigan residents who have health insurance through BCBSM should be aware of the company's subrogation policy. Subrogation is a process by which an insurance company recovers damages from a third party on behalf of its insured. In other words, if you are injured in an accident and your BCBSM health insurance pays for your medical expenses, the company may attempt to recover those costs from the person or organization responsible for the accident. While subrogation can be a helpful tool for insurers, it can also be frustrating for patients who are forced to deal with multiple claims and investigations. If you have questions about BCBSM subrogation or any other aspect of your health insurance policy, please contact an attorney experienced in this area of law.

Here is the data in regards to the form you were looking for to fill in. It can tell you the length of time you will require to finish bcbsm subrogation, exactly what fields you will have to fill in, and so on.

Form NameBcbsm Subrogation
Form Length1 pages
Fillable fields42
Avg. time to fill out8 min 43 sec
Other namesbcbs com subrogation, anthem subrogation, bcbsm unit, bcbsm subrogation com

Form Preview Example

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




Client’s 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 client’s name)


Date of Birth





Client’s phone number




Type of case (select one) Personal Injury

Product liability

Medical malpractice

Workers’ compensation

(Please fax the application if in Michigan)


Motor vehicle accident

In what state did it occur?






In what state does the liable party live?


Motorcycle accident

Was a vehicle involved? Yes














Venue/Jurisdiction of cause of action

Date of injuryType of injury/area of body injured


Attorney name

Attorney law firm name

Attorney street address




Zip code






Attorney phone number


Attorney fax number












Insurance company name










Insurance adjuster name


Insurance claim number







Insurance company street address




Zip code






Insurance adjuster phone number


Insurance adjuster fax number







Date and type of next scheduled hearing date











Blue Cross Blue Shield is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association

WF 10345 AUG 11

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entering details in bcbsm unit part 1

Put down the information in the Venue, Jurisdiction of cause of, Date of injury, Type of injury, area of body injured, NOTES:, Attorney name, Attorney law firm name, Attorney street address, Attorney phone number, Insurance company name, City, State, Zip code, and Attorney fax number field.

Completing bcbsm unit step 2

Put in writing any data you may need inside the box Insurance company name, Insurance adjuster name, Insurance claim number, Insurance company street address, City, State, Zip code, Insurance adjuster phone number, Insurance adjuster fax number, Date and type of next scheduled, Blue Cross Blue Shield is a, FAX COMPLETED FORM TO 877, 257, 2012 and W, F 10345 AUG 11.

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