Free Medical Bill Settlement Letter Template
Medical Bill Settlement Letter
I. Introduction
[YOUR NAME], on behalf of [YOUR COMPANY NAME], submits this letter as a formal proposal to settle the outstanding medical bills referenced in your account [PATIENT ACCOUNT NUMBER]. We aim to resolve this matter efficiently and amicably.
II. Patient Information
Before proceeding, please confirm the following patient details are correct:
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Patient Name: [PATIENT NAME]
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Service Date: [SERVICE DATE]
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Provider Name: [PROVIDER NAME]
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Amount Due: [AMOUNT DUE]
III. Settlement Offer
[YOUR COMPANY NAME] acknowledges an amount of [ORIGINAL AMOUNT] billed to our account. However, due to various discrepancies and negotiations, we propose a settlement of [SETTLEMENT AMOUNT].
III.Reasons for Settlement Offer
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Unclear billing items totaling [DISCREPANCY AMOUNT].
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Financial hardships detailed in our previous communications.
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Prior payments made totaling [PRIOR PAYMENTS].
IV. Terms of the Settlement
We request the following terms be adhered to upon acceptance of the settlement offer:
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Full and final settlement of the account upon payment of [SETTLEMENT AMOUNT].
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Removal of any negative reporting to credit agencies within 30 days of payment.
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An official settlement agreement to be mailed to [YOUR ADDRESS].
V. Confirmation of Settlement
Please confirm your acceptance of this settlement by signing and returning this letter by [RESPONSE DUE DATE]. Payment will be made within 15 business days of receiving the signed agreement.
VI. Contact Information
Should you have any questions regarding this settlement offer, please feel free to contact me directly:
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Email: [YOUR EMAIL]
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Phone: [YOUR PHONE NUMBER]
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Address: [YOUR ADDRESS]
V. Signature
[Patient Name]
[DATE]
[Your Name]
[DATE]
