The __________ (Concerned Authority),
________________ (Insurance Company Name),
Date: __/__/____ (Date)
Subject: Requesting reimbursement of medical
I would like to state that I am __________ (Name) a permanent resident of ______________ (Address) and I do carry a ________________ (Policy Name – If any) policy issued by your company having policy number _________ (Policy Number) in the name of ____________ (policy golder name).
I would state that on __________ (Date), _____________ (Patient’s Name) got admitted in ______________ (Hospital Name) and was admitted in ____________ (Room Type – Executive/ Simple/ Any Other) room. As per requirement I had already ___________ (intimated / submitted Claim approval request/pre approval authorization) on _________ (Date) with reference number ____________ (Reference Number).
I request you to kindly reimburse a sum of Rs. ____________ (Amount) in my bank account as cashless service was not available at the hospital due to which I had to pay for the bill.
The following are the details of the patient:
I am hereby attaching ____________ (Medical Card/ ID Proof/ Address Proof/ Bill/ Form Attested by Hospital – Any other document if applicable).
Respected, as I had to pay for the bill, therefore, I request you to kindly reimburse the amount in my account for the bill paid. I shall be thankful.
______________ (Contact Number)
Incoming Search Terms:
- Sample cover letter to the insurance company for claim amount reimbursement
- letter to insurance company fo reimbursement of claim amount