extract claim id and patient control number and denial reason from the following letter in tabular format "089-0192-PM 10/19
	SAMPLE LETTER TEMPLATE OF DENIAL APPEAL ‐ Medical Benefit   
	To Prescriber: Please refer to the important safety information in the full Prescribing Information when determining whether therapy is medically appropriate for the individual patient. 

Date: 01-01-2023 
Patient Name : NAME_1
Payor: UnitedHealth Group
             P.O. Box 1459
             NAME_2
	 MN 55440-1459 

ATTN: Prior Authorizations/Appeals 

Re:  Coverage of Lympho sarcoma

Provider: NAME_3
Policy Number : HU334FG
Group Number : OPIU9933 
Date of Birth: 01-01-1978
Diagnosis: Cardio Myopathy 
Submission Date: 01-11-2023 
Denial Date: 02-11-2023 
To whom it may concern: 
I am writing to request a review of a denial for coverage of UnitedHealth Care FlexWork for NAME_1. 
Your company has denied this claim for the following reasons: 
    • Technicalities: missing codes or authorizations, claim filing mistakes
    • Medical: treatment not considered a medical necessity or is considered experimental/investigational
Claim Number
Pat Ctl Number
GH442FFW
BUA88309

NAME_1’s medical history and course of treatment are as follows: 
A broken ankle suffered as a child isn't pertinent for a geriatric patient with a fever, confusion and hypotension, but a recent urinary tract infection, though, is very pertinent. Use follow-up questions about outcomes of previous illness or injury to gather add Write exactly 3 paragraphs each separated with two new lines answering this question. The first paragraph must start with "identity".
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