File Medical Claim Letter

File a claim with a medical insurance provider using this printable letter template.

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Susie Queue

123 Main St.

Anytown, CA 95928

(555) 555-1212

August 14, 2021

ABC Insurance

345 Any Place.

Anytown, CA 95928

To whom it may concern,

I am writing regarding a medical claim under policy number: ___________________

Here is the claim information:

Patient:

Provider:

Date:

I have attached a completed claims form, along with a statement from the provider.

I look forward to the prompt processing of this claim. Thank you.

Sincerely,

Enclosure: claims form

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