Medical Billing Dispute Letter

Date of the letter (required)

Your state (required)

Your full name (required)

Your mailing address (required)

Where the reply should be sent.

Your email or phone (optional)

Who are you writing to?

Hospital or provider name (required)

How will you send it?

Their mailing address (required)

Required when you mail it. The bill or the website lists it.

Account or patient number (optional)

Date or dates of the care (optional)

Amount you are disputing (optional)

By downloading, copying or printing, you agree that we save your name, email or phone, state and the document type — never the hospital, services, account numbers, amounts or dates — as explained in our Privacy Policy.

Sign the letter, keep a copy and keep proof of how and when you sent it (certified mail with a return receipt is one way).

Letter to dispute a medical bill

Letter to dispute a medical bill