Sample Medical Bill Reimbursement Application Format

Sample Medical Bill Reimbursement Application Format

[Here briefly focus on Medical bill reimbursement application format. You can also follow these as a covering letter for medical claim requesting reimbursement of medical expenses. You can modify this format as your requirement.]

Date…

Human Resource,

Medical Institution name…

Institute Address…

Sub: Application for Medical Bill Reimbursement

Dear Sir,

I was suffering from chronic Kidney disease (Disease name) from last few months. I have operated from (medical institute name). Total expense (Money amount) are incurred. Please reimburse this amount; I have attached all the necessary documents and Invoices.

I shall be highly grateful to you.

Name…

Job Designation…

Address and contact no…

Signature…

 

Another format,

Date…

Administration Office,

Medical Institution name…

Institute Address…

Sub: Request for Medical Bill Reimbursement

Dear Employer’s Name,

I am sending this letter to request reimbursement for the applicable medical expenses I have incurred due to (disease name). I was admitted to the (Name of Hospital), for five/seven days. I am enclosing all medical records pertaining to my treatment and hospitalization as well as the amount I am requesting for reimbursement for your perusal.

I hope to hear from you within 10 business days. If you need more information, you may reach me at (contact no) or at Name@email.com. I will be happy to supply any more information you require.

I appreciate your time and support.

Name…

Job Designation…

Address and contact no…

Signature…