Report Fraud Form | BlueCross BlueShield of South Carolina

Report Fraud

If you suspect someone of fraud, please let us know by filling out this form.

Important Note: Please know that this form is not sent via secure e-mail! So please do not include any confidential, personal health information on this form. If you will need to share confidential information, please include your contact information so we can contact you directly for details. Thank you!

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Person or Company You Suspect of Fraud

First Name

Last Name

Address 1

Address 2

City

State

ZIP Code

Phone

Date of Service or Incident

Brief Summary of Your ComplaintPlease do not include confidential information.

Customer This Affected

First Name

Last Name

Address 1

Address 2

City

State

ZIP Code

Phone

Your Information

(Optional! You may remain anonymous.)

First Name

Last Name

Address 1

Address 2

City

State

ZIP Code

Home Phone

Work Phone

Best Time to Call

E-mail

BlueCross BlueShield of South Carolina

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Report Fraud

Person or Company You Suspect of Fraud

Customer This Affected

Your Information