Free claim letter  04Free claim letter  04Free claim letter  04
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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: Your Name
Subscriber: xxxxxxxxxxxxx
Initial Date: XX-XX-XXXX
Date Created: XX-XX-XXXX
Policy Number: XXXXXXXXXX

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