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 billing dispute letter.

Medical Billing Dispute Letter Sample

[Joy Reed]
[4356 Blue Street]
[Oakland, CA, 00000]

[June 1, 2020]

[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 [05/15/2020] 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]

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