Medical Billing Dispute Letter [FREE 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
#3458769

June 1, 2021

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 05/15/2021 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 joy@email.com.

Thank you for you quick attention to this matter.

Sincerely,

Signature
Joy Reed
#3458769
List of Enclosures

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