Sunrise group of Insurance companies
345, St. Louis Street,
New York City.
12th April 2014
Subject: Insurance authorization letter
Dear Mr. Mathews,
This is to inform you that I, Bella Williams, resident of 34, Weatherly Woods, New York City, visited the Radiant Skin Care Hospital, in Northshere, New York, complaining about marks and stretches on her face on 1st April 2014. Medical examination, as recommended by the physician was done in this regards and I was diagnosed with HIV related Facial Lipoatrophy (ICD code 534.9 Lipoatrophy, 098 HIV).
My facial features are continuously deforming and hence it requires immediate medical help. It is very important for me to get proper treatment in order to regain my facial features back as normal.
Radiant hospital is a leading skin care hospital in the city and has solved thousand of cases similar to mine. After consulting about the various available options with my dermatologist, Dr. Doe Shepherd, she has decided to undergo serial dermal implants using Radiesse.
The treatment mentioned above has been successfully conducted by the doctor on number of patients before and is also approved by the FDA. I applied for the medical cover of the same from your company and I also want the hospital to be authorized to know about all the details of my medical cover, in order to proceed with my cure.
I herby, declare that the staff of Radiant Skin Care Hospital, under the supervision of Dr. Joe, is authorized to have an access of any sort of information related to my cover from you till the time I terminate the authorization in written, from you.