Business Letter – “Insurance Claim”

(Please use the following links to download a copy of this sample:)

Business Letter – “Insurance Claim” – .docx
Business Letter – “Insurance Claim” – .PDF

 
Blue Plus                                                                                     Katherine L. Pritchard
Consumer Service Center                                                    46 4th ST East, Apt 210
Route P3-2                                                                                    St. Paul, MN 55101
PO Box 64560                                                                                   (952) 300-7542
St. Paul, MN 55164                                                                  grmn1984@gmail.com

Monday, April 11, 2016

RE: Claim Number 6080900305000

To Whom It May Concern:

Blue Cross Blue Shield of Minnesota mailed a document to me (date of notice 04/02/2016), stating that services rendered for me regarding my health on 03/12/2016 at MNCome would not be paid for by Blue Plus as the “service or item is not covered in [my] benefit set. It is experimental or has not been proven to be safe or effective for [my] diagnosis.”

This letter serves as a formal appeal regarding Blue Cross Blue Shield’s decision to not pay the claim in question.

The services rendered were labs regarding an already existing diagnosis. These labs were not “experimental” in nature nor were they “unsafe” or “ineffective for my diagnosis”.

My endocrinologist would not have ordered the labs had they not been deemed medically necessary.

Please pay this claim (claim number 6080900305000) as soon as possible and notify me via writing once this has been completed.

I appreciate your time and your prompt attention to this matter. I look forward to your letter of acknowledgement.

Sincerely,

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Katherine L. Pritchard                                                                                04/11/2016
Enclosure

CC:

MNCome
1185 Town Center Drive
Suite 220
Eagan, MN 55123