Printable Medical Forms
File Medical Claim Letter Medical Form

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:









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.






Enclosure: claims form

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