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Anthem Blue Cross : Member Claim Forms

Member Claim Forms

PW_A114740

Healthy Families Program

 
Dear Member,  
Usually, all providers of health care will bill us directly for services to you and your enrolled dependent. This is the preferred procedure. You are not bothered with claim forms and we often need more details than are ordinarily provided on bills to patients. Sometimes, a physician may not bill us or an ambulance company, for example, may send the bill directly to you. In either instance, we have no way of knowing about your claim.  
This Member Claim Form was developed to notify us of any covered health service for which we have not already been billed. Please read the instructions on the form about how to report Health Care Services. We are happy to serve you.  
 
Send completed claim forms to:  
Anthem Blue Cross  
P.O. Box 60007  
Los Angeles, CA 90060-0007  
For questions regarding claims and benefits please call 1-800-845-3604.  
Member Claim Forms (PDF)

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.