Free Medical Billing Dispute Letter [Sample]

Learn how to write a medical billing dispute letter. Use our sample medical billing dispute letter as a template for your dispute letter.

Medical Billing Dispute Letter sample

Joy Reed
4356 Blue Street
Oakland, CA, 00000


June 1, 2022

ABC Hospital
Billing Department
7340 Hospital Street
Oakland, CA, 00000

Dear Billing Officer:

This letter is to formally inform you that the bill you gave me for treatment in your hospital on 05/15/2022 is inaccurate. I received treatment for a broken arm after a motorcycle accident on that day. 

Technicians took x-rays and set my arm, at which time I was discharged. The bill you gave me lists an MRI scan for the cost of $1,300, which I didn’t have.

I have included a copy of the bill with the MRI cost highlighted. I have also included the record of treatment given to me when I was discharged. As you can see, I did not receive an MRI scan.

Based on this information, I request that you send me a new bill that excludes the cost of an MRI scan. I have sent this request within the 30 day limit according to the instructions given to me by you for billing disputes.

I hope to hear from you within two weeks from the date you receive this letter. I can be reached at 525-123-4557 or at

Thank you for you quick attention to this matter.


Joy Reed
List of Enclosures

sample letter

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