To submit the Medical Expense Claim form, complete all required sections and attach the original bill from the healthcare provider. You can mail the completed form and attachments to Blue Cross and Blue Shield of Alabama's Claims Department at Post Office Box 995, Birmingham, Alabama 35298-0001. Alternatively, you can fax your claims to 205-220-2146 or 800-526-8529 for faster processing. Always ensure that the form is signed and dated before submission.

Important dates for submission of claims may include coverage start dates, claim deadline dates, and policy renewal dates. Always check the relevant policy for specific deadlines to ensure timely reimbursement. Updates for forms may occur annually, so stay informed.

The purpose of this Medical Expense Claim form is to allow patients to seek reimbursement for medical services rendered. It is designed to facilitate the submission of claims when healthcare providers do not file claims on behalf of the patient. Accurate filling is critical to ensure that claims are processed efficiently and payments are received as expected.

• 1. Patient's Name: Full name of the patient.
• 2. Contract Number: Unique contract identifier from the insurance ID card.
• 3. Group Number: Group health insurance number.
• 4. Patient's Date of Birth: Date of birth of the patient.
• 5. Patient's Sex: Gender of the patient.
• 6. Relationship to Contract Holder: Indicates the patient's relationship to the insurance policy holder.
• 7. Contract Holder Information: Information about the person holding the insurance contract.
• 8. Coverage under Other Insurance: Questions regarding coverage under any other health plan.
• 9. Medicare Benefits: Information about any Medicare benefits the patient may be entitled to.
• 10. Condition Related: Details if the claim is related to employment or accidents.
• 11. Diagnoses: Nature of the illness or injury.
• 12. Ordering Physician Details: Information regarding the physician who ordered or provided the treatment.

Failing to submit the claim form can lead to delayed reimbursements or complete denial of the claim. It’s crucial to ensure all information is accurate and complete prior to submission. Missing documents may also result in claims not being processed.

• Delayed Payments: Inaccurate or incomplete forms can delay reimbursement for medical expenses.
• Claim Denial: For failure to provide requested information or documentation, claims may be denied.
• Increased Stress: Errors in submissions can lead to confusion and frustration during the claims process.

• 1. After Receiving Treatment: Use this form to claim reimbursement for treatments received.
• 2. When Providers Don't File Claims: If your doctor or provider does not submit the claim, you can use this form.
• 3. For Prescription Drug Claims: Utilize this form when filing claims for prescription medications.