FOR PEOPLE AND FAMILIES · PAYING LESS

Pay what is fair, not what was printed.

Hospital assistance screening against the poverty guidelines, the itemized-bill request, a negotiation script built on the Medicare rate, a payment-plan calculator and the collections letter. Nothing is stored.

Do I qualify for hospital financial assistance?

2025 poverty guidelines

People in your householdHousehold income per year (before tax)State

Request the itemized bill

Your nameAccount numberProvider or hospitalDates of service

November 2, 2026

[Provider or hospital]
Patient Accounts

Re: Request for itemized bill and billing records
Patient: [patient name]
Account number: [account number]
Dates of service: [dates]

To whom it may concern,

Please send me a fully itemized statement for the account above, listing every item and service with its CPT/HCPCS or revenue code, the date, the number of units, the charge, and any payments or adjustments applied. Please also send the UB-04 or CMS-1500 claim form submitted to my health plan, if any.

Please place the account on hold, and do not refer it to collections, while I review the itemized statement. I will respond within 30 days of receiving it.

Thank you,

[patient name]
[address and phone]

Negotiate the balance

Balance owedWhat Medicare would pay (from the Bill Reader)What you can offer today

Call the billing office and ask for a supervisor or the patient financial services department.

"I'm calling about my bill from [provider] for [balance]. I've reviewed the itemized statement. Medicare would pay about [Medicare amount] for these services, and I understand your self-pay discount rate is available. I'm able to pay [offer] today in full settlement, or I can set up a payment plan on a reduced balance. Which can you approve?"

If they decline: "Can you tell me your self-pay discount and whether I qualify for financial assistance? Please send me the policy and the application."

If they agree: "Please send that agreement in writing before I pay, showing the account will be marked paid in full."

Keep notes: date, name of the person, and what was agreed.

MonthsDown payment (optional)

If it went to collections

Within 30 days of the collector's first notice, dispute in writing and demand verification; collection must pause until they send it. Send by a method that gives you proof of delivery.

Collection agencyAmount they claim

November 2, 2026

[Collection agency]

Re: Account [account number] · Amount claimed [amount]

To whom it may concern,

I dispute this debt and request verification under the Fair Debt Collection Practices Act, 15 U.S.C. 1692g. Please provide the name and address of the original creditor, an itemized statement of the services and charges that make up the amount claimed, the dates of service, and evidence that I am responsible for the amount.

Until you provide verification, please stop all collection activity on this account and do not report it to any credit bureau. Please communicate with me in writing only.

Sincerely,

[your name]
[address]

Credit reports: the three bureaus do not list medical collections under $500, remove paid medical collections, and wait a year before reporting one. A 2025 federal rule that would have removed medical debt from reports entirely was vacated in July 2025; some states have their own protections.

RVU-based Medicare benchmark, before payer adjustments, OPPS caps, sequestration, and patient cost sharing. An estimate, not a payment guarantee.