Marie Lefevre

Subject: Medical Claim - Emergency Surgery - Policy POL-2024-009876 Dear Claims Department, I am submitting a medical claim for emergency surgery and post-operative care received between March 28 and April 15, 2026. Summary of treatment: - Emergency appendectomy: $18,000 USD - ICU stay (3 days): $12,500 USD - Post-operative physiotherapy (8 sessions): $4,200 USD - Prescription medications: $1,800 USD - Follow-up specialist consultations: $8,500 USD Total claim amount: $45,000 USD All procedures were performed at Mercy Medical Center, Chicago, IL. Dr. Robert Nguyen (Surgeon) and Dr. Ana Perez (ICU) oversaw my care. Documents attached: medical certificate, itemized hospital receipts, surgeon report, pharmacy receipts, and insurance pre-authorization letter. Claimant: Marie Lefevre Policy holder since: 2019 Phone: +1-312-555-8899