Let's make your letter

Take your time. There are no wrong answers, and you can leave anything blank and fill it in later.

Private by design: everything you type stays in this browser tab. Nothing is sent to us or saved.

Have your bill, your insurer's Explanation of Benefits (EOB), or your denial letter nearby. They have most of the numbers you'll need.

What do you need?

About you Your full nameMailing address Phone or email (optional)

Who you're writing to Provider, hospital, or health plan nameTheir address (from the bill or denial letter)

The bill or claim

These are usually near the top of your bill or denial letter. Not sure? Leave it blank.

Patient name (if not you) Account, claim, or reference number Date of service Date on the bill or denial notice Amount billed or denied ($) Good Faith Estimate amount, if you were self-pay ($) What happened? What looks wrong? (check all that apply) Duplicate charge Service not received Insurance not applied Wrong details Payment not credited Date you sent your first letter What happened since? What did your first letter ask for? Denied service or treatment Reason given for the denial Is this urgent? (waiting could seriously harm health) Anything else you want to say (in your own words)

You'll be able to read and edit the letter before you use it.

Let's make your letter

Your letter