Balance Reduction Appeal Letter Free Download

Balance Reduction

Download "Balance Reduction Appeal Letter" Word Document

Appeal Letter Displayed for your convenience

Health Symphony Appeal Letter

For Balance Reduction

Your name, address and phone number


Medical Provider’s Address

Dear Dr _________:

I am writing to you in regards to a bill I received in the amount of [Dollar Total] for a medical service I received on [Date].

I fully intend to pay for the services provided to me while I was at your facility. However, as I do not have health insurance, the amount of my balance is large and would be difficult for me to pay. As a result, I have been conducting research on other patients who are considered “Self Pay” or “Cash Pay”.

My research has found that most facilities and medical providers have a Cash Pay Policy and automatically offer a substantially reduced rate for uninsured patients. The reasons for this is that most facilities usually always accept a negotiated or discount fee from health insurance plans and do not usually expect full payment. And second, the percentage collected from Cash Pay Patients is significantly low and knowing this, facilities attempt to work with their patients to recover some of the monies owed.

Based on this research and analysis, along with a review of what is considered Usual and Customary for the procedures performed for me while at your facility, I am offering to pay $_________, in ___ monthly payments of $_______.

Please honor my discount request and contact me at your earliest convenience or sign this document below if you agree to accept this negotiated fee. If I do not hear from you within 30 days, I will contact you again. Please do not initiate any collections activity until you have contacted me directly as I fully intend to pay what is fair and appropriate and would like to work out a payment arrangement with you.

Thank you for your time and assistance in this matter.


[Patient Name]