You are responsible for all content and all consequences if you adapt these template letters for your personal use. Our content is free because we earn a commission when you click or make a purchase from links on our site. Credit reporting agency City, State, ZIP]. Contact a qualified consumer attorney to assist with any credit, banking, or finance issues you face. /Tx BMC It should be sent by certified mail so that the patient or sender has proof of the time and date the letter was received. Cease any credit bureau reporting until the debt has been [name of provider] for them to release my medical information to a Known as the section 609 dispute letter or section 604 dispute letter, both dispute letters are similar. endstream endobj 224 0 obj <>/Subtype/Form/Type/XObject>>stream [ Or, if needed ] We are in receipt of you r itemized billing statement which is attached hereto as Exhibit "A". As you can see, I did not receive an MRI scan. The amount is in error because: Please remove this charge from my account. Sample Medical Billing Dispute Letter. I am further requesting the name of the person providing this data, and the manner in which it was provided, in order that I may pursue additional remedies. Box 2000, Chester, PA 19016 4. The usual time limits are 30 to 90 days from the date of the bill. agent. Box 2000, Chester, PA 19016 4. The dispute needs to be put in writing in a medical billing dispute letter that is sent to the billing department. Use this letter for paid medical collections. [Name of credit reporting agency Microsoft Edge. Sample Medical Collection Removal Letter … to allowing me to validate it may be a violation of the Fair Credit I am writing in response to your letter or phone call dated _____. Each disputed item should be listed and a request should be made that the inaccurate charges be removed. withholding the information you received from any medical provider You dispute medical accounts this way: DO NOT send it CERTIFIED OR RR SEND IT PRIORITY MAIL WITH PROOF OF DELIVERY ONLY-WAIT FOR THE FULL RESPONSE FROM THE CRA BEFORE CONTINUING WITH THE HIPAA LETTER PROCESS NEW INITIAL DISPUTE LETTER . twofold—validation of debt and HIPAA authorization. When a hospital bills for medical care, the bills are often incredibly vague and wordy. Are you a legal professional? ! A written statement that the patient believes the bill is in error. Thank you in advance for your prompt attention to this matter. See ���@�ӹ��'+#A${�8a�KcQԕ`�#R=H�g=HL̲*���1:w@\� ��èy��y���Τ��,[�A1��a���d Ӈ��g�͠��A�:��o�^��v��L��?`���E��������܂� �}��Ap���ܐ¤%)3�1$K-�^E�w@�c��� ��)JE�$�{,�,-b�$��y��d�#׹Y�%y4�,/-�o�>�HKVp� Some states have laws about how much hospitals can charge self-pay patients. It should be sent by certified mail so that the patient or sender has proof of the time and date the letter was received. h�b```f``������)� Ā B@1v� If the dispute needs to be taken to a government agency or consumer advocacy group for help, they will require proof that the hospital or doctor has been formally asked to address the issue. information about me but anything more is to only be revealed with If the patient doesn’t get any response from the billing department, they should address the letter to the chief financial officer or chief executive office of the hospital or both. full documentation of what you received from the provider of service Be sure to keep a copy of your letter and always send a letter like this “Certified with a Return Receipt”. However, it can be done, but should follow certain terms and conditions so that there is no possibility the hospital or doctor involved can decline on a technicality. third party. I have also included the record of treatment given to me when I was discharged. validated by me. due and your bill does not include a breakdown of any fees. The medical billing dispute letter should state that the patient expects a response within a reasonable period of time such as two weeks from the date they receive the letter. endstream endobj 231 0 obj <>/Subtype/Form/Type/XObject>>stream All rights reserved. I received treatment for a broken arm after a motorcycle accident on that day. If you send any information with the letter, send copies and keep your originals. -�XS��^`@�O$-��_ the patient’s authorization. The following information must be given in writing according to federal requirements: • Identification of the bill in dispute• A written statement that the patient believes the bill is in error• The reason the bill is being disputed. I am aware that the HIPAA does allow for limited /Tx BMC endstream endobj 235 0 obj <>/Subtype/Form/Type/XObject>>stream Be very sure to don’t dispute optimistic things on your credit report. Internet Explorer 11 is no longer supported. Other requirements prevent the creditor from taking certain actions until the creditor complies with the requirements of resolving a billing error claim: the creditor may not (1) close the account, (2) make or threaten to make an adverse report regarding nonpayment of the disputed amount, or (3) attempt to collect the amount in dispute. p ��b�x,k9d�p}�tc�\���w��Ob Fill in all fields highlighted in yellow with your information. Therefore my request is SignatureJoy Reed#3458769List of Enclosures. Here is a sample medical billing dispute letter. I recommend you check out the statute of limitations on medical bills as well. Item 2, referenced on page __ of the billing … endstream endobj 229 0 obj <>/Subtype/Form/Type/XObject>>stream Always check your bills for errors, because creditors sometimes do make mistakes and credit-card theft may have occurred without your knowledge. Additionally, any reporting of this debt to the credit bureaus prior I am writing with regard to account number [account number] from [name of original creditor] on my personal credit report. �D`0� ���� ��@E|.Q+$�����>L/` Visit our professional site », Created by FindLaw's team of legal writers and editors I have sent this request within the 30 day limit according to the instructions given to me by you for billing disputes. You may consider “return receipt requested,” for proof that the credit reporting company received it. Dear Billing Officer: This letter is to formally inform you that the bill you gave me for treatment in your hospital on 05/15/2020 is inaccurate. Learn more about how we make money. To trigger the federal requirements, the written notice must provide the creditor with the following: (1) account identification information, (2) identification of the specific bill (or bills) in dispute, (3) a statement that the debtor believes the bill is in error, and (4) the reason(s) why the bill is disputed. and medical charges. records from third parties. I received a bill from you on [date] and as allowed under the Fair Sample bill dispute letter Hospital Bill Reduction Service. �. Technicians took x-rays and set my arm, at which time I was discharged. not received a copy of your bill itemization. The usual time limits are 30 to 90 days from the date of the bill. endstream endobj 227 0 obj <>/Subtype/Form/Type/XObject>>stream I recommend you check out the statute of limitations on medical bills as well. SAMPLE LETTER TO COLLECTION AGENCY . f Keep a copy of the letter for your records. They can state that they tried to settle the matter with the billing department but failed. Please send this information to my address listed above and accept In addition, the notice must be sent within 60 days of receipt of a bill containing the error. 1.8 1.44 5.52 3 re If the patient is a self-pay patient, they should check their state’s laws about doctors and hospitals overcharging. *�Z��� 4܍;m�J�㶜ivAo}���3i�m�r�``o k�P�0 � (����������A�a>7k��� 2� � � �o0F0\c``ib�bM����æ�4�qB���M7dMa|��� ��u�ՁiP��0���/H�P��!,���� , R�������R��p�A�� %���J@��4 m����P�u��i��W˴g�|��Tg�E�]��!�.~%&���)x,8����ԡ��T{H3�>�\c�)s� �^cs endstream endobj 221 0 obj <>/Metadata 49 0 R/Pages 218 0 R/StructTreeRoot 95 0 R/Type/Catalog/ViewerPreferences 255 0 R>> endobj 222 0 obj <>/MediaBox[0 0 612 792]/Parent 218 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 223 0 obj <>/Subtype/Form/Type/XObject>>stream The 609 letter is similar to a debt verification letter you would send to a third-party collector when trying to validate the legitimacy of a balance due, which is your right under the Fair Debt Collection Practices Act.The 609 letter, however, is based on Section 609 of the Fair Credit Reporting Act (FCRA), a federal law that regulates the credit reporting agencies.

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