Writing a Medical Claim Letter [with Sample]

A medical insurance claim letter may be required if an individual’s doctor or other healthcare provider did not submit the required documents for a claim to the individual’s medical insurance company. 

The patient has the right to any healthcare benefits they pay for or get through their job. If this happens, the claimant may be able to resolve the issue with a claim letter.

Before Sending The Letter

Before sending the letter, the patient should make sure that they are following all the conditions of their medical insurance policy. There may be required forms that they need to get and fill out to enclose with their letter. 

They should also be sure that the treatment they would like covered by their insurance is actually listed on their policy. This includes prescription medication and some tests.

Deductions

There will be deductions that the claimant needs to pay before the insurance company starts to pay. The patient should make sure that all the required deductions have been paid before sending the letter. The insurance company will not reimburse this amount. 

In many cases, patients have to file medical claims themselves if they don’t get help from the doctor or hospital. In these cases, they need to pay all the medical bills and expenses themselves before being discharged from the hospital, clinic or nursing home. 

The insurance company will only give compensation after the bills are paid, and the patient is discharged. 

Some of the basic requirements for filing a claim are:

• A completed claim form
• Original receipts, bills and hospital discharge papers in chronological order beginning 30 days before treatment or hospitalization and 60 days after discharge.
• Bills for prescription drugs
• Copies or the results of tests or receipts for tests with a letter from the doctor who prescribed the tests
• Surgeon’s bill if applicable

When writing a medical insurance claim letter, there are some things to consider. The letter should be written as soon as possible after the treatment. Most insurance companies require claims to be submitted within seven days of discharge from the hospital of completion of the treatment.

Be Brief And To The Point

The letter should be brief and to the point. The purpose of the letter should be stated in the first sentence. It should only contain the details of the claim request and the policy number. This is not the place to complain about the mistake of the doctor for not sending the information.

If possible, the letter should be address to the person who will deal with the claim. The patient may call the insurance company to get the name of the third-party administrator to whom the letter should be addressed.

The letter should also state the terms of the policy that apply to the patient’s case. For example, if the policy covers prescription medication, the letter can state that they are requesting reimbursement for prescription medication as indicated in the policy.

Documents That Support The Claim

Any documents that support the claim should be enclosed with the letter. If possible, these should be copies and not original documents.

However, some insurance companies require both copies of all receipts, reports and notes as well as the original. If this is the case, the patient should be sure to keep copies of everything.

This may include bills and receipts or letters from the doctor or medical technician proving that treatment was required by a qualified physician. Each document should be directly relevant to the treatment received.

Here is a sample medical insurance claim letter. It should be written in formal business style and sent by certified mail, so the sender has proof of the time and date it was received.

Normally, it should only contain copies of all documents, but in some cases the insurance company may require original documents.

Sample Medical Insurance Claim Letter

Claimant’s Name
Claimant’s Address
City, State, Zip Code

DATE

Insurance Administrator’s Name
Insurance Company’s Name
Insurance Company’s Address
City, State, Zip Code

Dear Name of Administrator:

This letter is to formally request reimbursement for medical expenses for policy NUMBER. I was visiting New York City on DATE where I fell and broke my wrist. 

I was treated at NAME OF HOSPITAL, and because I was from out-of-state, I needed to pay the bill in full. The amount was $3500 for x-rays, a bone specialist and one night in the hospital.

According to the terms of my policy, I contacted my primary healthcare physician within 24 hours of the accident. I have enclosed all the documents related to my treatment. 

I understand that I have a $500 deductible on my policy. I am requesting you to reimburse me $3000 in keeping with my health care coverage. 

I can be reached at 555-123-4567 or at Name@email.com if you have any questions. Thank you for your quick attention to this. 

Sincerely,

Signature of Claimant
Printed Name of Claimant
List of Enclosures

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