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Write a letter regarding problems related to billing.

 

Dear Customer Service Department:

I, hereby, request that [name of medical group OR health plan] cover a bill I received for [service, treatment OR procedure]. The service was provided on [date] by [name of provider (doctor, lab, hospital, other)] to address [medical problem]. The bill I received is for [amount] and must be paid by [date]. Since this bill should be covered by my [medical group/health plan], therefore, I called the concerned [medical group/health plan] on [date(s)], and spoke with [name of representative] concerning the bill, but the problem has not yet been resolved.

I would like to state the reasons as why this bill should be paid by [name of medical group/health plan], namely:

  • [name of service] is a covered service under my health plan coverage terms;
  • a referral for [service, treatment/procedure] was provided by my primary care physician;
  • [service, treatment OR procedure] was performed by my primary care physician;
  • [service, treatment OR procedure] was performed by a specialist to whom I was referred by my primary care physician;
  • the services were medically necessary;
  • there are no coverage exclusions or limitations of [service, treatment OR procedure], or that apply to my case;
  • I have met all of my co-payment or deductible obligations under the health plan’s coverage terms;
  • I could not get prior authorization before receiving [service, treatment/procedure] because my health care problem was an emergency. I called my [primary care physician, health plan/medical group] as soon as I could after receiving the [service, treatment/procedure], as required by my health plan.

 

I would like to emphasize that the [medical group/health plan’s] failure to pay the bill violates [national/state] law which requires [applicable legal requirement]. I am also attaching documentation supporting your responsibility for the bill. Kindly respond in writing about the actions you will take regarding this request.

Thank you for your prompt attention to this matter.

Sincerely,

 

 

 




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