Sample "Letter to Insurance Company for Medical Claim"

A Letter to Insurance Company for Medical Claim is a document that individuals can use when they would like to claim a use for their medical insurance. The purpose of the document is to notify your insurance provider that you want them to cover your medical expenses.

Commonly, this type of letter is prepared by a policyholder when they need to receive treatment that is listed in their insurance policy. In addition to the claim, they can also be required to provide other documents as evidence that the treatment is necessary. A sample Letter to an Insurance Company for a Medical Claim can be downloaded below.

Your medical claim can contain the following parts:

  1. Introduction. In the first part of the document, you can designate your identifying information (name and address) and your insurance policy details. These details can include your insurance policy number, member ID, and more.
  2. Medical Details. Here, you can provide the insurance company with information about what kind of health conditions you are experiencing, medical treatment needs to be covered, how this medical treatment will help you, etc.
  3. Conclusion. At the end of the letter, you can express your hope to hear from the insurance company soon and offer to answer any of the questions they may have.

Still looking for a particular letter? Take a look at the related templates and samples below:

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Sample Letter to Insurance Company
for Medical Claim
From: Bert Kelley
2743 Glenview Drive
Binghamton, New York 47252
+1 472-462-9003
[Date]
To: Audrey Copeland
573 Meadow View Drive
Ames, Iowa 56735
Dear Mrs. Copeland,
This letter is to formally request reimbursement for medical expenses for policy number
4628-7002. I was visiting New York City on April 2nd, 2020 where I fell and broke my
wrist.
I was treated at Rainbow Clinic, and because I was from out-of-state, I needed to pay the
bill in full. The amount was $3200 for X-Rays, a bone specialist, and one night in the
hospital.
According to the terms of my policy, I contacted my primary healthcare physician within
24 hours of the accident. I have enclosed all the documents related to my treatment. I
understand that I have a $200 deductible on my policy. I am requesting you to reimburse
me $3000 in keeping with my health care coverage.
I can be reached at +1 472-462-9003 or at
bert27kelley@mail.com
if you have any
questions. Thank you for your attention.
Sincerely,
Bert Kelley
[Signature]
©
TEMPLATEROLLER.COM
Sample Letter to Insurance Company
for Medical Claim
From: Bert Kelley
2743 Glenview Drive
Binghamton, New York 47252
+1 472-462-9003
[Date]
To: Audrey Copeland
573 Meadow View Drive
Ames, Iowa 56735
Dear Mrs. Copeland,
This letter is to formally request reimbursement for medical expenses for policy number
4628-7002. I was visiting New York City on April 2nd, 2020 where I fell and broke my
wrist.
I was treated at Rainbow Clinic, and because I was from out-of-state, I needed to pay the
bill in full. The amount was $3200 for X-Rays, a bone specialist, and one night in the
hospital.
According to the terms of my policy, I contacted my primary healthcare physician within
24 hours of the accident. I have enclosed all the documents related to my treatment. I
understand that I have a $200 deductible on my policy. I am requesting you to reimburse
me $3000 in keeping with my health care coverage.
I can be reached at +1 472-462-9003 or at
bert27kelley@mail.com
if you have any
questions. Thank you for your attention.
Sincerely,
Bert Kelley
[Signature]
©
TEMPLATEROLLER.COM