Writing a Strong Medical Billing Dispute Letter (with Sample)
Use this sample medical billing dispute letter as a template for your formal dispute letter.
Last updated on March 16th, 2023
Disputing mistakes on a bill is not easy for any industry, but disputing medical bills is especially difficult. 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. The dispute needs to be put in writing in a medical billing dispute letter that is sent to the billing department.
Time Limit for Disputes?
Most billing disputes are honest mistakes, which is why there is a time limit for disputes. The usual time limits are 30 to 90 days from the date of the bill. There are also requirements for the doctor or hospital. They may not give an adverse report to a credit bureau or attempt to collect the amount in dispute unless the error is resolved or the patient paid the bill.
The following information must be given in writing according to federal requirements:
Time Limit for Disputes?
Most billing disputes are honest mistakes, which is why there is a time limit for disputes. The usual time limits are 30 to 90 days from the date of the bill. There are also requirements for the doctor or hospital. They may not give an adverse report to a credit bureau or attempt to collect the amount in dispute unless the error is resolved or the patient paid the bill.
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
The patient needs to clearly state or give a copy of the itemized bill with the items and services that have been billed in error. Each disputed item should be listed and a request should be made that the inaccurate charges be removed.
If the hospital or doctor refuses to do this, they need to be asked for written documentation that supports the charges made. It is recommended for every patient to keep personal notes about the services and procedures they receive from any health care giver. This is a precaution in the event there disputes later.
Billing Dispute
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. The patient may also mention that he or she will follow up with a phone call.
If the hospital or doctor refuses to do this, they need to be asked for written documentation that supports the charges made. It is recommended for every patient to keep personal notes about the services and procedures they receive from any health care giver. This is a precaution in the event there disputes later.
Billing Dispute
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. The patient may also mention that he or she will follow up with a phone call.
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. They can state that they tried to settle the matter with the billing department but failed. Any reputable medical facility will want to make good on an error.
If, after contacting all the officials in the hospital or doctor’s office, the patient doesn’t get any help, he or she should contact the department of public health in their state. Most of these departments have consumer complaint links on their websites.
Self-Pay Patient
If the patient is a self-pay patient, they should check their state’s laws about doctors and hospitals overcharging. Patients without insurance are often charged up to four times more for the same procedure as patients with insurance. Some states have laws about how much hospitals can charge self-pay patients.
Here is a sample medical billing dispute letter. It should be sent by certified mail so that the patient or sender has proof of the time and date the letter was received. 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.
The letter should be in formal business style and copies of any invoices, bills or documents of proof of treatment need to be enclosed. No original documents should be sent unless requested by the hospital or doctor. In this case the sender should retain a copy.
If, after contacting all the officials in the hospital or doctor’s office, the patient doesn’t get any help, he or she should contact the department of public health in their state. Most of these departments have consumer complaint links on their websites.
Self-Pay Patient
If the patient is a self-pay patient, they should check their state’s laws about doctors and hospitals overcharging. Patients without insurance are often charged up to four times more for the same procedure as patients with insurance. Some states have laws about how much hospitals can charge self-pay patients.
Here is a sample medical billing dispute letter. It should be sent by certified mail so that the patient or sender has proof of the time and date the letter was received. 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.
The letter should be in formal business style and copies of any invoices, bills or documents of proof of treatment need to be enclosed. No original documents should be sent unless requested by the hospital or doctor. In this case the sender should retain a copy.
Sample Medical Billing Dispute Letter
Patient’s Name
Patient’s Address
City, State, Zip Code
Patient’s Bill or ID Number
DATE
Hospital or Doctor’s Name
Billing Department
Hospital or Doctor’s Address
City, State, Zip Code
Dear Name of Billing Officer:
This letter is to formally inform you that the bill you gave me for treatment in your hospital on DATE is inaccurate. I received treatment for a broken arm after an automobile 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 AMOUNT, 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 555-123-4567 or at [email protected]
Thank you for you quick attention to this matter.
Sincerely,
Signature of Patient
Printed Name of Patient
Patient’s Billing or Treatment Number
List of Enclosures
Patient’s Name
Patient’s Address
City, State, Zip Code
Patient’s Bill or ID Number
DATE
Hospital or Doctor’s Name
Billing Department
Hospital or Doctor’s Address
City, State, Zip Code
Dear Name of Billing Officer:
This letter is to formally inform you that the bill you gave me for treatment in your hospital on DATE is inaccurate. I received treatment for a broken arm after an automobile 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 AMOUNT, 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 555-123-4567 or at [email protected]
Thank you for you quick attention to this matter.
Sincerely,
Signature of Patient
Printed Name of Patient
Patient’s Billing or Treatment Number
List of Enclosures
Frequently Asked Questions (FAQs)
Q: What is a medical billing dispute letter?
A: A medical billing dispute letter is a written communication sent by a patient or their representative to a healthcare provider or insurer to challenge or dispute a charge or a denial of payment for a medical service. The letter should clearly outline the details of the dispute, including the service or treatment received, the date it was provided, and the amount charged or denied.
Q: When should I consider writing a medical billing dispute letter?
A: You should consider writing a medical billing dispute letter if you receive a medical bill that you believe is incorrect or if an insurer denies payment for a medical service that you believe is covered under your policy. Examples of situations that may warrant a dispute letter include billing errors, duplicate charges, services that were not provided, services that were denied as not medically necessary, and out-of-network charges.
Q: What information should I include in a medical billing dispute letter?
A: A medical billing dispute letter should include your name, address, and contact information, as well as the name and address of the healthcare provider or insurer. You should also include a clear and concise explanation of the dispute, including the date of service, the amount charged or denied, and the reason for the dispute. Supporting documentation, such as medical records or receipts, should also be attached to the letter.
Q: How should I format my medical billing dispute letter?
A: Your medical billing dispute letter should be written in a professional and business-like manner, using a clear and concise tone. The letter should be typed, using a standard font such as Times New Roman or Arial, and should be formatted with clear headings and subheadings. It should also include a clear and specific subject line, such as "Medical Billing Dispute Letter."
Q: How should I send my medical billing dispute letter?
A: You should send your medical billing dispute letter via certified mail with return receipt requested, so that you have proof of delivery. You may also want to consider sending a copy of the letter via email or fax for expedited delivery. It is important to keep a copy of the letter and all supporting documentation for your records.
Q: What should I expect after sending a medical billing dispute letter?
A: After sending a medical billing dispute letter, you should receive a response from the healthcare provider or insurer within a specified timeframe. The response may include a resolution to the dispute, a request for additional information, or a denial of the dispute. If the dispute is not resolved to your satisfaction, you may need to consider other options, such as filing a complaint with a regulatory agency or seeking legal counsel.
A: A medical billing dispute letter is a written communication sent by a patient or their representative to a healthcare provider or insurer to challenge or dispute a charge or a denial of payment for a medical service. The letter should clearly outline the details of the dispute, including the service or treatment received, the date it was provided, and the amount charged or denied.
Q: When should I consider writing a medical billing dispute letter?
A: You should consider writing a medical billing dispute letter if you receive a medical bill that you believe is incorrect or if an insurer denies payment for a medical service that you believe is covered under your policy. Examples of situations that may warrant a dispute letter include billing errors, duplicate charges, services that were not provided, services that were denied as not medically necessary, and out-of-network charges.
Q: What information should I include in a medical billing dispute letter?
A: A medical billing dispute letter should include your name, address, and contact information, as well as the name and address of the healthcare provider or insurer. You should also include a clear and concise explanation of the dispute, including the date of service, the amount charged or denied, and the reason for the dispute. Supporting documentation, such as medical records or receipts, should also be attached to the letter.
Q: How should I format my medical billing dispute letter?
A: Your medical billing dispute letter should be written in a professional and business-like manner, using a clear and concise tone. The letter should be typed, using a standard font such as Times New Roman or Arial, and should be formatted with clear headings and subheadings. It should also include a clear and specific subject line, such as "Medical Billing Dispute Letter."
Q: How should I send my medical billing dispute letter?
A: You should send your medical billing dispute letter via certified mail with return receipt requested, so that you have proof of delivery. You may also want to consider sending a copy of the letter via email or fax for expedited delivery. It is important to keep a copy of the letter and all supporting documentation for your records.
Q: What should I expect after sending a medical billing dispute letter?
A: After sending a medical billing dispute letter, you should receive a response from the healthcare provider or insurer within a specified timeframe. The response may include a resolution to the dispute, a request for additional information, or a denial of the dispute. If the dispute is not resolved to your satisfaction, you may need to consider other options, such as filing a complaint with a regulatory agency or seeking legal counsel.