________
________
________
________
________
RE: Policy Number ________
Dear Sir or Madame,
I am writing to ________ to file a claim for the following:
Patient: ________
Provider: ________
Date Services Rendered: ________
I have enclosed the following supporting documentation:
-- A completed claims form
-- A statement from the provider
-- ________
If any additional follow up is required, please contact me by phone at ________.
55522 225 225 2255 252222 522222822 22 2588 252225.
Best,
________
Enclosures
________
________
________
________
________
RE: Policy Number ________
Dear Sir or Madame,
I am writing to ________ to file a claim for the following:
Patient: ________
Provider: ________
Date Services Rendered: ________
I have enclosed the following supporting documentation:
-- A completed claims form
-- A statement from the provider
-- ________
If any additional follow up is required, please contact me by phone at ________.
55522 225 225 2255 252222 522222822 22 2588 252225.
Best,
________
Enclosures
Answer the question, then click on "Next."
The document is written according to your responses - clauses are added or removed, paragraphs are customised, words are changed, etc.
At the end, you will immediately receive the document in Word and PDF formats. You can then open the Word document to modify it and reuse it however you wish.
