Visit our Forms page to download forms for managing your Louisiana Blue account. Mail or fax the forms using the mailing address or fax number listed on each form.
Commonly Used Forms
Authorized Delegate- Use to give us permission to share your protected health information with another person or company.
Other Coverage Questionnaire- Use to inform us about other medical coverage you have or confirm you don’t have medical coverage with another carrier. This information should be updated if you add, change, or remove coverage to ensure claims process accurately.
Medical Appeal Form- Use to appeal a medical benefit decision.
Medical Claim Form- Use this form to file a claim when a non-participating provider does not file it for you.
NOTE: Participating providers file claims for you, so this form isn’t needed for their services.
All Other Forms
For all other forms, go to the Forms and Tools page on www.lablue.com.