|Class of Service:||Coverage Pays:||Your Copay Is:|
|Class I - Preventative Services||90%||10%|
|Class II - Restorative Services||90%||10%|
|Class III - Denture & Bridges||50%||50%|
|Class IV - Orthodontics Services||50%||50%|
$1000 annually for Class I, II and III services combined
$1000 lifetime for Class IV (orthodontic) services
Every effort is made to provide accurate information. However, this is not a guarantee of payment. Treatment will be rendered based on BCBS's payment liability, we recommend you request a predetermination for your treatment plan prior to having any services rendered.
Blue Cross Blue Shield of Michigan (BCBS PPO participants)
Customer Service Office:
Open 8:30 a.m. – noon and 1:00 – 5:00 p.m.
225 East Wesley
Customer Service Information:
Monday – Friday 8:30 a.m. to 5:00 p.m.
Please send all correspondence to:
Blue Cross Blue Shield of Michigan
Costumer Service Center
P.O. Box 2888
Detroit, MI 48231
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