Blue Care Network Physician Selection Forms

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you've enrolled in a Blue Care Network plan, use this form to choose your primary care physician.

As a Blue Care Network member, you'll need to choose a primary care physician. You can choose a different physician for each member of your family or one to care for your entire family. You can also change your current physician.

BCN Primary Care Physician Selection Form (PDF)

What you'll need:

  • Your enrollee ID card
  • A printer to print the form
  • An envelope and postage to mail the form, or a fax machine.

Step by step instructions:

  1. Select your primary care physician. Find a doctor that participates in Blue Care Network.
  2. Complete the form, sign and return it to us as soon as you enroll so that we can notify your doctor of your membership.

Fax or mail the form to:

Blue Care Network
Mail Code C300
P.O. Box 5043
              Southfield, MI 48086-5043

Fax: 1-877-218-1466

If you have any questions, please contact us.

You can also change your primary care physician online by logging in to your account at bcbsm.com. See How can I choose or change my primary care physician online for more information.

You can also change your primary care physician through our mobile app. Download the mobile app here.