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Medical Claim Letter

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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 ________


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

-- ________

If any additional follow up is required, please contact me by phone at ________.

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Best,





________




Enclosures

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

-- ________

If any additional follow up is required, please contact me by phone at ________.

Facba pcb bcf pcbf dfcadf cffabffcb fc fafa acffaf.

Best,





________




Enclosures