High call volumes

Our member and provider services may be experiencing higher than normal call volumes from 12/22/25-1/9/26 due to a large number of staff being out of office.  We encourage you to utilize alternative forms of communication including secured messaging through online Member Services and Availity Essentials Provider Portal.

Show More

BCBSND district offices will be closed to the public on Friday, Dec. 26.

This includes Bismarck, Grand Forks, Jamestown and Minot. Need help? We’re here for you! Log in at BCBSND.me or call 844-363-8457.

Show More

We are unable to accept walk-ins on Friday, Dec. 26, and Friday, Jan. 2., due to short staffing.


Show More

Out-of-State Non-Participating Health Care Provider Waiver Form

This form is for BCBSND members who need non-urgent, non-emergency care from a provider outside of North Dakota who is non-participating.

Find a Doctor to see if you can get care from participating (non-urgent & non-emergency) providers to lower your cost.

Submit this waiver if:

  • You are getting certain mental health or substance use services, like intensive outpatient or partial hospitalization programs.
  • You need specialized services such as durable medical equipment, lab testing, radiology, or wound grafting.
  • You’re seeking non-emergency services from a provider who is not part of the Blue Cross Blue Shield network.

Important things to know:

  • Even with an approved waiver, your costs will be based on what BCBSND considers reasonable for the service. 
  • Even with an approved waiver, your costs will be based on your BCBSND coverage as outlined in your enrolled plan. You are responsible for any charged above the plan allowance.
  • If you do not get a waiver for services that require one, those costs may not be covered.
  • Some services may require prior authorization.

* Indicates required fields

Member Information

*Required Fields

Please enter a valid Date.

Residential Street Address

Mailing Address

Please note, the determination of your request will be mailed to the mailing address if different from the residental address.

Submitter Information

*Required Fields

Submitter Address

Provider Information

*Required Fields

Facility Address

Service Information

Date can not be more than 120 days before or after today's date.

Review

*Required Fields

Who is this waiver for? : Edit

Member Information

Member First Name : Edit
MI : Edit
Member Last Name : Edit
Member Date of Birth : Edit
Member ID : Edit
Member Contact Phone Number : Edit
Address Line 1 : Edit
Address Line 2 : Edit
City : Edit
State : Edit
ZIP Code : Edit
Mailing Address same as Physical Address? : Edit

Submitter Information

Submitter First Name : Edit
Submitter MI : Edit
Submitter Last Name : Edit
Submitter Contact Phone Number : Edit
Address Line 1 : Edit
Address Line 2 : Edit
City : Edit
State : Edit
ZIP Code : Edit

Provider Information

Provider First Name (optional) : Edit
Provider Last Name (optional) : Edit
Facility Name : Edit
Facility NPI (optional) : Edit
Address Line 1 : Edit
Address Line 2 : Edit
City : Edit
State : Edit
ZIP Code : Edit
Service type : Edit
Reason for appointment : Edit
Date of Service/Care : Edit

By checking this box, I understand I am creating an electronic signature that carries the same legal obligations as a written signature and am agreeing to all of the terms and conditions set forth within this application, including the Notification and Authorization.