Understanding the Collection Letter Sample For Medical Office: A Guide for Patients and Practices

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] [Patient Name] [Patient Address] Subject: Reminder: Your Recent Medical Visit - Account #[Account Number] Dear [Patient Name], We hope this letter finds you well. This is a friendly reminder that your recent visit on [Service Date] for [Brief Description of Service, e.g., your annual check-up] has an outstanding balance of $[Amount Due]. We noticed that this amount is now past due according to our records. We understand that sometimes things can be overlooked. We've attached a copy of your statement for your reference. Please submit your payment of $[Amount Due] by [New Payment Due Date]. You can make a payment online at [Website Link for Payments], by mail to the address above, or by calling us at [Your Office Phone Number]. If you have already made this payment, please disregard this notice. If you have any questions or would like to discuss a payment plan, please don't hesitate to contact our billing department at [Your Office Phone Number]. Sincerely, The Billing Department [Your Medical Office Name]

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] [Patient Name] [Patient Address] Subject: Second Notice: Overdue Balance for Account #[Account Number] - Action Required Dear [Patient Name], This is our second notice regarding the outstanding balance of $[Amount Due] for services rendered on [Service Date]. Our records indicate that this amount is now significantly past due, and we have not yet received your payment. We value you as a patient and want to ensure there are no barriers to your continued care. Prompt payment helps us continue to provide high-quality medical services to our community. Please make arrangements to pay the full amount of $[Amount Due] immediately. You can find payment options listed below:

1. Online: [Website Link for Payments]
2. By Mail: Send a check or money order to [Your Office Address]
3. By Phone: Call us at [Your Office Phone Number] to pay with a credit/debit card

If you are experiencing financial hardship, please contact our billing department at [Your Office Phone Number] as soon as possible to discuss potential payment arrangements. We look forward to resolving this matter promptly. Sincerely, The Billing Department [Your Medical Office Name]

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] [Patient Name] [Patient Address] Subject: Final Notice: Urgent Action Required on Overdue Account #[Account Number] - Potential Collections Dear [Patient Name], This letter serves as our final attempt to resolve the outstanding balance of $[Amount Due] for services provided on [Service Date]. Despite our previous communications, we have not yet received your payment or a response from you. This balance is now severely overdue, and we must inform you that if payment is not received within [Number, e.g., 10] days of the date of this letter, your account may be turned over to an external collection agency. This could impact your credit history. We urge you to take immediate action to settle this debt. The total amount due is $[Amount Due]. You can make a payment through any of the following methods:

• Online: [Website Link for Payments]
• Mail: [Your Office Address]
• Phone: [Your Office Phone Number]

If you have already sent your payment, please disregard this notice and accept our apologies. If you wish to discuss this matter or explore payment options before it is escalated, please call us immediately at [Your Office Phone Number]. We hope to avoid further action and appreciate your prompt attention to this serious matter. Sincerely, The Billing Department [Your Medical Office Name]

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] [Patient Name] [Patient Address] Subject: Your Account Statement and Payment Plan Options - Account #[Account Number] Dear [Patient Name], We are writing to provide you with a detailed statement of your account with us, reflecting the services provided on [Service Date]. The current outstanding balance is $[Amount Due]. We understand that unexpected medical expenses can sometimes be difficult to manage. To help you resolve this balance, we are pleased to offer flexible payment plan options. We are willing to work with you to set up a plan that fits your budget. Please review the enclosed statement for a breakdown of charges. We encourage you to contact our billing department at [Your Office Phone Number] by [Date] to discuss setting up a personalized payment plan. We can explore options for breaking down the $[Amount Due] into manageable monthly installments. If you prefer to pay the full amount, you can do so through our website at [Website Link for Payments], by mail, or by calling us. We believe in working with our patients to ensure access to care and smooth financial resolutions. We look forward to hearing from you soon. Sincerely, The Billing Department [Your Medical Office Name]

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] Medical Office Payment Plan Agreement This agreement is made between [Your Medical Office Name] ("Provider") and [Patient Name] ("Patient") for the outstanding balance on account #[Account Number] related to services rendered on [Service Date]. Total Outstanding Balance: $[Amount Due] Agreed Payment Schedule: The Patient agrees to pay the outstanding balance in [Number] installments of $[Monthly Payment Amount] each. Payments are due on the [Day] of each month, beginning on [First Payment Date]. 1. Payment 1: $[Monthly Payment Amount] due on [Date] 2. Payment 2: $[Monthly Payment Amount] due on [Date] 3. ... (continue for all installments) 4. Final Payment: $[Final Payment Amount] due on [Date] Method of Payment: Payments can be made via check, money order, online at [Website Link for Payments], or by calling [Your Office Phone Number]. Late Payments: Payments not received by the due date may incur a late fee of $[Late Fee Amount] per installment. Default: Failure to adhere to this payment plan may result in the acceleration of the entire balance due and potential referral to a collection agency. Patient Signature: _________________________ Date: ____________ Provider Representative Signature: _________________________ Date: ____________ Sincerely, The Billing Department [Your Medical Office Name]

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] [Patient Name] [Patient Address] Subject: Regarding Your Account #[Account Number] and Insurance Coverage Inquiry Dear [Patient Name], We are writing to follow up on your account with us. Our records indicate an outstanding balance of $[Amount Due] for services rendered on [Service Date]. We understand you believe your insurance should cover this amount. We have reviewed our records and the claim submitted to your insurance provider, [Insurance Company Name], on [Date Claim Submitted]. Unfortunately, the claim was either denied or resulted in a patient responsibility portion of $[Amount Due]. The reason provided by your insurance was: [Reason for Denial/Patient Responsibility, e.g., "service not medically necessary," "deductible not met," "out-of-network provider"]. We recommend that you contact [Insurance Company Name] directly at [Insurance Company Phone Number] to discuss the denial or patient responsibility and to understand their decision. You may need to provide them with specific information about your visit. Please be advised that our office policy requires payment for services rendered. If you have made a payment directly to your insurance company that should have been applied to this balance, please provide us with proof of that payment. If you have any questions regarding the services provided, please do not hesitate to contact our office at [Your Office Phone Number]. Sincerely, The Billing Department [Your Medical Office Name]

[Your Medical Office Name] [Your Office Address] [Your Office Phone Number] [Your Office Email Address] [Date] [Patient Name] [Patient Address] Subject: Important: Your Recent Payment for Account #[Account Number] - Returned Check Dear [Patient Name], This letter is to inform you that the check we received from you for your payment on account #[Account Number] has been returned by your bank. The reason for the return was [Reason for Return, e.g., "insufficient funds," "account closed," "refer to maker"]. The amount of the returned check was $[Amount of Check]. Additionally, our office incurs a returned item fee of $[Returned Item Fee Amount], as per state law and our office policy. Therefore, the total amount now due is $[Total Amount Due = Amount of Check + Returned Item Fee]. Please arrange for payment of the full amount of $[Total Amount Due] immediately. We can no longer accept personal checks from this account. Acceptable forms of payment include:

• Cash
• Money Order
• Cashier's Check
• Credit/Debit Card (call us at [Your Office Phone Number])

Please make your payment by [New Payment Due Date]. Failure to do so may result in further action, including the possibility of your account being sent to a collection agency. We urge you to resolve this matter promptly to avoid any additional fees or complications. Sincerely, The Billing Department [Your Medical Office Name]