Follow the steps below to register as an out-of-network practitioner with Premera BCBS of Alaska:

  • Download and complete the for located here:

  • 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 or fax: 425-918-4937.