Sample 1
Dear Mr/Mrs. «Recip_LastName»
It’s our policy to contact patients who received a billing statement from us in the past 30 days, but have
not responded.
You currently have a balance of $ «Patient_PatBalance» with «Patient_ProviderName» To date we have
not received payment or have heard from you regarding payment arrangements.
If you have a question regarding your bill or need help reading your insurance’s EOB, we’d be happy to
help. We understand medical billing is not always simple to understand, but we can help.
We understand that many of our patients experience financial difficulties. If this is the case, please let us
know so we can assist you in making budget payment arrangements. We want to help you fulfill your
commitment without causing undue hardship, so please do not hesitate to contact our offices.
If you have already sent payment in, then please, disregard this letter. Otherwise, we look forward to
receiving your payment within five days of this letter. Your prompt attention is appreciated. Dr.
«Patient_ProviderName» would appreciate it very much.
Sincerely,