Request For Insurance EOB From Patient

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


Patient Name
Patient Address
City, State  Zip

Dear _____:

I am enclosing a copy of the letter we received from [secondary insurance company]. As you can see, they will not process your secondary claim without a copy of the Explanation of Benefits (EOB) that was included with the payment from your primary insurance carrier, [primary company name].

Because the checks go to you, we do not receive the EOB. If you could mail or fax a copy of the primary carrier EOB, I will be glad to process this claim for you.



Jane Doe
Financial Coordinator for Dr. _____