Subrogation Form
Subrogation is the legal right that allows Blue Cross Blue Shield of Wyoming to pursue reimbursement for paid claims from a third party including but not limited to members own auto insurance that is financially liable for an accident or injury to Wyoming members.
The following form helps us collect detailed information to determine if a party is financially responsible for the treatment provided to Wyoming members.
Important!
If you received a letter from BCBSWY and have already returned the questionnaire or responded by other means, you do not need to complete this form. If you did not receive a questionnaire but want to report an accident or injury including a car accident, please complete the following information. Thank you for your cooperation and assistance.
Attorneys: If you are representing a BCBSWY member in a subrogation case, please email a valid HIPAA authorization and your Letter of Representation to [email protected] and our subrogation specialist will be in touch regarding any potential liens.