Global Voyager Assistance Black Sea

77/79, Nezhinskaya Street, Odessa, 65023, Ukraine

Phone: +380 48 73 73 441 (Alarm Line)
+380 48 73 73 442
Fax:
E-mail: ukraine@gvassistance.com Internet: http://www.gvassistance.com

Verification of Benefits
To:

Dr. Georgiy Rezvan

Company: Dr. Georgiy Rezvan

Contact:

docgeorgy@hotmail.ru

Vasiliva Nailia
Subscriber:
Date of Birth (Age): 15.12.1950
Case No. (Our Ref.): M-317721

From:

Volkova, Anastasia

Date:

18.04.2015 19:54:38

Doc. No.:

M-151469

Page:

Insurance Company: RGS

150-1408VIR-1537109
Policy No.:
10.04.2015 - 27.04.2015
Valid:

Dear Sirs,
Global Voyager Assistance is the assistance company acting on behalf of RGS Insurance Company, with
whom the above mentioned has a current policy covering medical expenses. According to the policy
terms policy holder is entitled to emergency medical care and transportation. These expenses are
covered by the insurance company.
Request:

Dear colleagues, please provide our client with the initial consultation of GP. Adress:
1 1 Note rhat
our client doesn't have telephone so we will tell her by emai to stay in app untill you'll
comel.Follow up visits must be pre-approved.

Problem:

Pain when urinating, frequent urination

Please note that the policy has a deductible 0 which has to be paid by the Insured directly.
To confirm coverage of medical expenses we need to receive the following documentation:
* The complete medical report with the description of treatment undertaken
* The estimate of total reasonable and customary charges
* The copy of patient's insurance policy

These documents must be forwarded as an attachment to the following e-mail address

info@gvassistance.com (preferable) or by fax to the number +7 495 775 0 998 for the attention of
GVA Operations Department with the indication of our reference number M-317721 NOT LATER
than 24 hours from the moment of delivery of services!
Your kind assistance is very much appreciated.
Anastasia Volkova
Assistance Coordinator

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