Letter generator

Pick the situation, fill in the blanks, and take the letter away. Each template quotes the rule it rests on — the No Surprises Act, IRS section 501(r), the Fair Debt Collection Practices Act — so the recipient knows you are describing an actual obligation rather than asking a favor.

🔒 Your letter is never uploaded. It is assembled in this browser and saved only to this device's storage. If you ask us to email the follow-up schedule, we receive your email address and which template you used — never the letter, the amounts, or any name in it.

Your situation

The first letter to send about any medical bill. A summary bill hides what you were actually charged for; an itemized bill lists every line with its billing code, which is the only version you can check for duplicates, unbundling, or services you never received.

The lever: You cannot dispute what you cannot see — an itemized statement converts a single alarming number into individual, checkable lines. Read the full guide

Your full name

Your address

Today's date

Who you are writing to

Their address

Account or bill number

On the bill, usually top right. Include it so your letter reaches the right file.

Date of service

Your letter

6 fields still to fill — placeholders shown in brackets.

[YOUR FULL NAME]
[YOUR ADDRESS]

2026-08-01

[WHO YOU ARE WRITING TO]
[THEIR ADDRESS]

Re: Account [ACCOUNT OR BILL NUMBER] — request for an itemized statement
Date of service: [DATE OF SERVICE]

To whom it may concern,

I am writing to request a fully itemized statement for the account above, covering services provided on [DATE OF SERVICE].

Please include, for each line item: the date of service, a plain-language description, the billing code (CPT, HCPCS, or revenue code), the quantity, the unit charge, and the total charge. Please also include any charges billed by providers other than your facility that appear on this account.

I am reviewing this bill before making payment arrangements, and I would like to verify each charge against the care I actually received. I am not disputing the account at this time; I am asking for the detail necessary to review it.

Please send the itemized statement to the address above. I will follow up in writing if I have not received it within 30 days.

Sincerely,

[YOUR FULL NAME]

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This is a template, not legal advice.

After you send it

Letters work because of what follows them. Send by certified mail with return receipt where you can — proof of delivery is what makes a deadline real.

Day 14No response yet? Call the billing department and ask them to confirm the request is logged, then note the date, time and the name of the person you spoke to.
Day 30Still nothing? Send the same letter again by certified mail with return receipt, and reference the date of your first request.
Day 45Once the itemized bill arrives, work through it with the billing-error checklist before agreeing to any payment plan.

What this letter rests on

Email me the follow-up schedule

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