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Free Medical Benefits Request - Additional Professional Support for Claim

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Dear _________________:

 

Enclosed is a copy of my insurance company's response to my claim for _________________ care. As you can see, they only wish to pay _________________ of the total _________________ billed.

 

This is not good news. However, they may reconsider the claim if they are presented with additional information, such as a physician's report, describing extenuating circumstances.

 

Could you please send them a letter in which you explain some aspect of my care that would justify what they consider to be a high fee? I don't know which aspects of my case would be most relevant to them, but perhaps you do. I'd certainly appreciate it if you'd give it a try.

 

Their name and address is: _________________, _________________, _________________, _________________ _________________. My policy number is _________________. My case is in _________________, with Identification Number _________________.

 

Thank you so much for your help. Could you please ask your office staff to send me a copy of the letter you sent my insurance company? That will enable me to refer to it when I call them to follow up.

 

Sincerely,

 

 

 

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