Email Member Services - State of Maryland

E-mail Member Services

E-mail Security

Since e-mail is not a secure form of communication, we are unable to answer the following types of questions by e-mail:

Questions about your medical condition or your treatment plan.
Please contact your primary care physician if you have medical questions.

Questions that require sending confidential information.
(Social Security number, medical information, benefit information, mental health)
Please call the Member Services number on your ID card with all benefit and claim questions.

First Name:

Last Name:

Address Line 1:

Address Line 2:

(optional)

City:

State:

Zip:

Country:

Day Phone:

Night Phone:

E-mail:

Preferred Method of Contact: (optional)

(If your question is regarding claims or eligibility we may need to contact you by phone.)

Day Phone Night Phone E-mail Regular Mail

What Type of Insurance Do You Have?

CareFirst BlueChoice (HMO)

Point of Service (POS)

Preferred Provider Organization (PPO)

My Question is About:

Benefit/Eligibility A Claim Other

Patient's First Name:
Patient's Last Name:
Patient's Date of Birth:
Patient's Relationship to Policy Holder:
Provider:	(optional)
When was the Service Provided:	(optional)

Description of Service: (optional)

Have you received your Explanation of Benefits? Yes No (optional)

If you are NOT the Policy Holder: (optional)

(If you are not a member on the policy, a written response will be sent to the policy holder.)

Your Name: (optional)

Relationship to Policy Holder: (optional)

Questions or Comments: (optional)

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Confidentiality Statement

Members' Rights & Responsibilities

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Serving Maryland, the District of Columbia and portions of Virginia. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.

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