Back to top

Letter to Claim from Medical Insurance

Progress:
0%
?
X

Select whether or not the person writing this letter is also the person who is making the medical claim.

Need
help?
Customise the template

________
________

________

________
________


RE: Policy Number ________


Dear Sir or Madame,

I am writing to ________ to file a claim for the following:

Patient: ________

Provider: ________

Date Services Rendered: ________

I have enclosed the following supporting documentation:

A completed claims form

A statement from the provider

Evidence of the expenses which have been incurred

________

As a result, I am claiming reimbursement in the amount of $________ (Australian dollars). This can be paid in the following manner:

________

If any additional follow up is required, please contact me using the details above. Thank you for your prompt attention to this matter.


Yours faithfully,




________

See your document in progress

________
________

________

________
________


RE: Policy Number ________


Dear Sir or Madame,

I am writing to ________ to file a claim for the following:

Patient: ________

Provider: ________

Date Services Rendered: ________

I have enclosed the following supporting documentation:

A completed claims form

A statement from the provider

Evidence of the expenses which have been incurred

________

As a result, I am claiming reimbursement in the amount of $________ (Australian dollars). This can be paid in the following manner:

________

If any additional follow up is required, please contact me using the details above. Thank you for your prompt attention to this matter.


Yours faithfully,




________