Medical Bill Dispute Letter

Answer a few questions and we'll create your personalized letter.

Your Situation

Tell us about the medical billing issue so we can tailor your dispute letter.

State where services were received

This determines which state balance billing and medical billing protections apply in addition to the federal No Surprises Act.

What type of billing dispute is this?

Select the option that best describes your dispute. This determines which federal and state protections your letter will cite.

Patient status at time of service

This affects which protections apply. The No Surprises Act protects insured patients from surprise balance bills. The Good Faith Estimate provision protects uninsured/self-pay patients.

Was this an emergency service?

Yes — emergency room, urgent care, or emergency transportNo — scheduled or non-emergency service

The No Surprises Act prohibits balance billing for ALL emergency services regardless of network status.

Date of service

The date you received the medical services in question. If services spanned multiple days, use the first date.

Total amount billed

The total amount shown on your bill.

Amount you believe you owe

Your good-faith estimate of what you actually owe after insurance, corrections, or adjustments. Enter 0 if you believe you owe nothing.

Amount already paid

How much you have already paid toward this bill, if anything.