Add Medical Reimbursement
On my honor I confirm the following:
1. I have previously paid my provider directly before funds were available on my MasterCard.
2. I recognize that my reimbursement calculation is based in the REAL AMIOUNT due my provider (after all discounts or coupons) versus amount paid by BCBS. I confirm that I am requesting a reimbursement only for the actual amounts I paid directly.
Medical Reimbursement Details