Fill Out Your Medical Claim Form

Click here to download the form. After completing it, submit your form, itemized receipt, and prescription to the address that’s located on the back of your health insurance ID card.

Attach Your Prescription & Receipt

The receipt will be provided in your package. You’ll also be able to download a copy by heading over to your account.

Submit Your Form, Prescription, & Receipt

Please note that masks that include headgear and machines with humidifiers will not have the costs broken down by item, as they are packaged items. Feel free to contact us if your insurance provider has any questions.

Get Your Reimbursement

You’ll get your reimbursement approximately 2-3 weeks after submitting your claim. The amount of time may vary based on your insurance provider.

Fill Out Your Medical Claim Form

You can either submit a Universal Claim Form or a State-Specific Form.

For the Universal claim form, download the form and call the customer service number that’s on your health insurance ID card. Ask for the mailing address for the claim forms. After completing the form, submit your form, itemized receipt, and prescription to the address that your insurance company provided you with.

For the State-Specific Claim Form, head to the Blue Cross Blue Shield website and find your local company. Once you’re on the page of your specific Blue Cross Blue Shield company, search for "medical claim form” and download it. After completing the form, submit your form, itemized receipt, and prescription to the address on the form.

Attach Your Prescription & Receipt

The receipt will be provided in your package. You’ll also be able to download a copy by heading over to your account.

Submit Your Form, Prescription, & Receipt

Please note that masks that include headgear and machines with humidifiers will not have the costs broken down by item, as they are packaged items. Feel free to contact us if your insurance provider has any questions.

Get Your Reimbursement

You’ll get your reimbursement approximately 2-3 weeks after submitting your claim. The amount of time may vary based on your insurance provider.

Fill Out Your Medical Claim Form

Click here to download the form. After completing it, submit your form, itemized receipt, and prescription to this address: Claims Processing Kaiser Permanente P.O. Box 30766 Salt Lake City, UT 84130-0766.

Attach Your Prescription & Receipt

The receipt will be provided in your package. You’ll also be able to download a copy by heading over to your account.

Submit Your Form, Prescription, & Receipt

Please note that masks that include headgear and machines with humidifiers will not have the costs broken down by item, as they are packaged items. Feel free to contact us if your insurance provider has any questions.

Get Your Reimbursement

You’ll get your reimbursement approximately 2-3 weeks after submitting your claim. The amount of time may vary based on your insurance provider.

Fill Out Your Medical Claim Form

Click here to download the form. After completing it, submit your form, itemized receipt, and prescription to the address that’s located on the back of your health insurance ID card.

Attach Your Prescription & Receipt

The receipt will be provided in your package. You’ll also be able to download a copy by heading over to your account.

Submit Your Form, Prescription, & Receipt

Please note that masks that include headgear and machines with humidifiers will not have the costs broken down by item, as they are packaged items. Feel free to contact us if your insurance provider has any questions.

Get Your Reimbursement

You’ll get your reimbursement approximately 2-3 weeks after submitting your claim. The amount of time may vary based on your insurance provider.

Fill Out Your Medical Claim Form

Click here to download the form. After completing it, submit your form, itemized receipt, and prescription to the address that’s located on the back of your health insurance ID card.

Attach Your Prescription & Receipt

The receipt will be provided in your package. You’ll also be able to download a copy by heading over to your account.

Submit Your Form, Prescription, & Receipt

Please note that masks that include headgear and machines with humidifiers will not have the costs broken down by item, as they are packaged items. Feel free to contact us if your insurance provider has any questions.

Get Your Reimbursement

You’ll get your reimbursement approximately 2-3 weeks after submitting your claim. The amount of time may vary based on your insurance provider.

Fill Out Your Medical Claim Form

Click here to download the form. After completing it, submit your form, itemized receipt, and prescription to the address that’s located on the back of your health insurance ID card.

Attach Your Prescription & Receipt

The receipt will be provided in your package. You’ll also be able to download a copy by heading over to your account.

Submit Your Form, Prescription, & Receipt

Please note that masks that include headgear and machines with humidifiers will not have the costs broken down by item, as they are packaged items. Feel free to contact us if your insurance provider has any questions.

Get Your Reimbursement

You’ll get your reimbursement approximately 2-3 weeks after submitting your claim. The amount of time may vary based on your insurance provider.