Sample Medical Claim Letter

April 15, 2005

ABC Insurance Corporation
St. Joseph Subd.
Balanga City

Dear Ms. Solomon:

I am formally request reimbursement for my medical expenses for policy number, A41572. I was hospitalized for 1 week on April 2 to April 8, 2005 due to pneumonia at St. Luke’s Hospital. My wife needed to pay the bill in full. The amount was Php 55,000 for x-rays, laboratory expenses, rooms and medicines.

According to the terms of my policy, respiratory disease like pneumonia is covered. I have enclosed all the documents related to my treatment. I am requesting your good office to reimburse me Php55,000 in keeping with my health care coverage.

I hope for your cooperation regarding this matter. I can be reach at 09451257853 if you have any clarifications.

Thank you for quick action.

Sincerely,

Angelina D. Agaloos