Billing Dispute Letter
What this letter does
This letter tells the hospital or doctor’s office which charges you think are wrong, and why, and asks for a corrected bill. Use it when you have the itemized bill in hand and can point to a real problem: the same test billed twice, a service you never got, or a date that does not make sense.
Sample letter
Billing Dispute Letter
This is a sample, not your letter. The names and numbers are made up.
SAMPLE — not a real letter. Names, amounts, and account numbers are fictional.
May 4, 2026 Jordan Sample 123 Sample Street Anytown, ST 00000 Northbridge Health System Patient Financial Services 400 Example Avenue Anytown, ST 00000 RE: Billing dispute — Account ACCT-0000-SAMPLE, dates of service February 2–3, 2026, statement dated April 22, 2026 To whom it may concern: I have reviewed the itemized statement for the account above and found specific errors. I am disputing $587.00 of the $1,940.00 balance and requesting a corrected statement before I make any payment on the disputed portion. The errors are as follows: 1. Duplicate charge. Line 7 and line 12 both bill CPT 71046 (chest X-ray, two views) for February 2, 2026 at $312.00 each. I had one chest X-ray during this visit. One of these charges should be removed ($312.00). 2. Service not received. Line 15 bills CPT 96365 (intravenous infusion, initial hour) for February 3, 2026 at $275.00. I was discharged the evening of February 2, 2026 and was not at the facility on February 3. My discharge paperwork, enclosed, shows the discharge time. This charge should be removed ($275.00). I am not disputing the remaining $1,353.00 at this time, but I ask that you confirm the corrected balance in writing before I pay it. Please (a) remove or correct the charges identified above, (b) send me a revised itemized statement, and (c) place the entire account on hold, without late fees, interest, or referral to a collection agency, while this dispute is reviewed. If any of the disputed charges has already been submitted to my insurer, please also send a corrected claim. I ask that you reply in writing. If I have not received a written reply by June 8, 2026, I will follow up and may also raise this with my insurer and my state’s consumer protection office. Please use the mailing address above for all correspondence. Thank you. Sincerely, Jordan Sample Enclosures: Copy of itemized statement dated April 22, 2026; copy of discharge summary dated February 2, 2026When not to use it
Do not use it before you have the itemized bill. Without the line-by-line list, you cannot say which charge is wrong.
This sample is here to read, not to copy. A letter only works with your own facts, dates, and account numbers.
BillFighter is not a law firm and this page is not legal advice. We are not lawyers. If you are being sued, or your situation is complicated, talk to a lawyer or a legal aid office.
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