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Health care services: Use this section to report any COVERED health service that has not already been reported to this Anthem Blue Cross and Blue Shield plan by
SpecialOffers@Anthem Fitness Reimbursement Program
This form will be returned if: 1) The form is not completed with the required information and 2) an original receipt and completed log card or fitness center
Please complete and send this form to Blue View Vision within one (1) year from the original date of service by the providers office. 1. When visiting a
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