Return To Previous Page
Report Suspected Fraud, Waste, Abuse, or Other General Compliance Concerns


Information submitted in this form is neither secure nor encrypted.  All information we receive from you is strictly confidential, and you may remain anonymous if you wish.

You may also report suspected fraud, waste, abuse, or other general compliance concerns by calling our Incident Reporting Line at 616.575.6388
.

Insured's
First Name:
Last Name:
Address:
City, State & Zip:
Phone Number:

Person or Company Suspected of Fraud, Waste, Abuse or Other General Compliance Concerns
Name:
Address:
City, State & Zip:
Phone Number:

Details of Situation

Your Information (optional if you wish to remain anonymous)
First Name:
Last Name:
Address:
City, State & Zip:
Phone Number:
E-mail Address:




© 2019 Grotenhuis. ALL RIGHTS RESERVED
588 3 Mile Road NW Suite 101, P.O. Box 140167, Grand Rapids, MI 49514-0167
Phone: (800) 748-0368 or (616) 949-7950 Fax: (877) 329-2844 or (616) 949-2502


Grotenhuis is an Authorized Independent Managing Agent for Blue Cross® Blue Shield® of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are non-profit corporations and independent licensees of the Blue Cross and Blue Shield Association.