From,
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
To,
[Recipient’s Name]
[Insurance Company Name]
[Address]
[City, State, ZIP Code]
Subject: Reimbursement Claim for Medical Expenses – [Your Full Name]
Dear [Recipient’s Name],
I am writing to submit a claim for reimbursement of medical expenses incurred during the period [Date of Treatment]. The details of the medical treatment are as follows:
– Medical Service Provider: [Name and Address of Medical Provider]
– Diagnosis and Treatment Received: [Brief description]
– Total Amount Incurred: [Total Amount]
I have attached copies of all relevant documents, including invoices, receipts, and medical reports for your reference. Please find these documents enclosed with this letter.
Policy Details:
– Policy Number: [Your Policy Number]
– Plan Type: [Type of Plan]
I kindly request your prompt attention to this matter and the reimbursement of the claimed amount. I appreciate your assistance in processing this request as quickly as possible.
Thank you for your attention to this matter, and I look forward to a favorable resolution.
Sincerely,
[Your Full Name]
[Your Signature – if sending a hard copy]
