[Your Name]
[City, State ZIP Code]

[Medical Provider’s Name]
[City, State ZIP Code]

Subject: Dispute of Medical Bill [Invoice Number]

Dear [Medical Provider’s Name],

I am writing this letter to dispute an error in the medical bill I received from your office for services rendered on [Date of Service]. The invoice I received is for [$Amount] and I believe that this amount is incorrect.

I would like to bring to your attention the following issues with the bill:

[List the specific issues or errors with the bill, including any overcharges or charges for services not received. Provide detailed explanations and supporting evidence, such as copies of previous bills or receipts, if available.]

I request that you review my account and make the necessary corrections. I would also appreciate it if you could provide an itemized statement that clearly shows the charges and services provided.

I would like to resolve this issue as soon as possible and I am available to discuss this matter further if needed. I am confident that this issue can be resolved quickly and amicably through your assistance.

Thank you for your prompt attention to this matter.


[Your Signature]
[Your Name]

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