EFTA00316355.pdf

UnitedHealthcare Insurance Company P.O. BOX 30655 Salt Lake City, UT 134130-0555 UnitedHealthearex Patient: Jeffrey J. Epsten Ref fr: C7252113314GFOA IMember. Jeffrey Epstein Member ID: XXXXX5597 Group: SOUTHERN TRUST COMPANY 254CEISAA1002001-07467-01 Group 0272605 STUART I ORSHER • Letter ID: INFO002 9 EAST 71ST STREET NEWYORK NY 10021 September 9, 2017 Dear Stuart I. Orsher: We reviewed your request regarding Jeffrey J. Epstein for 51,490.00. Unfortunately, we do not have a record of a claim for this amount. If you would like us to consider these health care expenses, we need more information. Please provide the following information: • A copy of the UB-92 or CMS 1500 claim form (These forms are used by physicians, health care professionals or facilities to bill insurance companies.) • A copy of this letter • Any supporting documentation that shoves the date the claim was originally submitted Mail the information and this letter to the above return address. Keep a copy for your records. If you have questions about this letter, please call us toll-free at 1-877-842-3210. Sincerely, The UnitedHealthcare Team IIIII IIIII II IIHIII III iii iii IIII I IIIIIII it II11111111 IIIIIII11111 III EFTA00316355