Free Medical Benefit Explanation Letter Design

Name: Free Medical Benefit Explanation Letter Design Template
Brand: Template.net
Availability: InStock

Medical Benefit Explanation Letter Design

[Your Name]
[Your Address]

[Your Email]
[Your Phone Number]

July 2, 2051

Mary Smith
Claims Specialist
MS Health Insurance Company
456 Elm Street
New York, NY 10001

Subject: Explanation of Medical Benefits

Dear Ms. Smith,

I hope this letter finds you in good health and spirits. I am writing to provide a clear and concise explanation of the medical benefits associated with my recent healthcare services under Policy Number XYZ123456.

Medical Benefit Details

Patient Name: [Your Name]
Policy/Account Number: XYZ123456
Service Dates: June 10, 2050 – June 12, 2050
Claim Number: CLM7891011
Healthcare Provider: Sunnydale Hospital

The purpose of this letter is to explain the coverage for medical benefits related to my recent hospitalization and the services rendered. This includes treatment for a diagnosed respiratory infection, which requires consultation, X-rays, and prescribed medications.

Coverage Breakdown

The services provided include the following:

Consultation with Specialist:
- Amount Billed: $250.00
- Amount Covered: $200.00
- Patient Responsibility: $50.00
Chest X-Ray:
- Amount Billed: $500.00
- Amount Covered: $400.00
- Patient Responsibility: $100.00
Prescribed Medications:
- Amount Billed: $150.00
- Amount Covered: $120.00
- Patient Responsibility: $30.00

These benefits are in line with the terms and conditions outlined in my medical benefits plan. Should there be any discrepancies or additional clarification needed, I would be happy to address them promptly.