Payment Related Letters

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Payment Related Letters

Template letters (in Word) related to payment that pediatric practices can customize.

Notification of Practice’s Financial Policies 
Template letter notifying patients/families with insurance that includes high out-of-pocket expenses (deductibles and co-pays) about the practice’s financial policies. 


Outstanding Patient Account Balance Letter​​
Template letter to patients/families alerting them of an outstanding patient account balance.  

Families Without Health Insurance
Template letter for patients and families who do not have health insurance. Briefly discusses coverage options and self-pay discounts. 

Response to Bill Questions​​
Template letter to update a patient/family after they have questioned a bill.

Practice Dropping Insurance Plan​
Template letter to patients/families advising them that their practice will no longer accept a specific insurance plan or the pediatrician is no longer an in-network provider.   

Pending Application for Medicaid Coverage​​
Template letter to patients/families informing them of practice’s procedures for patients with pending Medicaid applications. 

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