Follow the steps below to register as an out-of-network practitioner with Premera BCBS of Alaska:
Download and complete the for located here: https://www.premera.com/documents/021127.pdf
You will select the option: "Add or remove a practitioner”
For “please specify the reason for submitting this form” please write: “Purpose: add provider as a non-participating/ Out of network provider”
Once complete, Send the completed form by email at firstname.lastname@example.org or fax: 425-918-4937.