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Letter to Claim from Medical Insurance

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

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RE: Policy Number ________


To Whom It May Concern,

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:

________

52 522 5558282258 228828 52 88 52858525, 282582 8222582 22 58822 252 5225888 58282. Thank you for your prompt attention to this matter.


Yours faithfully,




________

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________
________

________

________
________


RE: Policy Number ________


To Whom It May Concern,

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:

________

52 522 5558282258 228828 52 88 52858525, 282582 8222582 22 58822 252 5225888 58282. Thank you for your prompt attention to this matter.


Yours faithfully,




________