Free claim letter  04Free claim letter  04Free claim letter  04
Download the document to the computer for easy use
There are more pages to preview,Read on

Your Name
Your Address
Your Address
Anthem Blue Cross and Blue Shield
PO Box 105187
Atlanta, GA 30348

Reference No: XXXXXXXXXX
Provider: N/A
Specialist: Penny Lane
Patient DOB: XX-XX-XXXX
Patient: Your Name
Subscriber: xxxxxxxxxxxxx
Initial Date: XX-XX-XXXX
Date Created: XX-XX-XXXX
Policy Number: XXXXXXXXXX
DATE

To whom it may concern:
I am writing to request reimbursement for covered services I received through Penny Lane, DNP,
CNM, IBCLC and Believe Midwifery Services, LLC, which operates as a cash-only practice.

The services of Believe Midwifery are very cost effective. In Indianapolis, IN, a hospital birth with no
interventions costs approximately $ 14,000 to $18,000. The cost of my homebirth was much less,
and the care I received was much more time intensive and thorough.
Please also bear in mind that my labor included the complication of premature rupture of membranes
(PROM) at X:XX PM on DAY, DATE. Our baby was born at X:XX PM on DAY, DATE - nearly 46 hours
later. Management