Deliver a medical billing statement with payment options and financial assistance information.
Includes required fields, attachments, and recipients
Takes <30 seconds. No setup required.
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Subject
Billing Statement — patient_first_name
billing-statement
Hi patient_first_name,
Please find your billing statement attached. This reflects your patient responsibility after any applicable insurance payments and adjustments.
STATEMENT SUMMARY
• Statement Date: statement_date
• Amount Due: $amount_due
• Payment Due Date: due_date
The attached statement provides a detailed breakdown of services rendered, charges, any insurance payments applied, and any adjustments. Please review it carefully and contact our billing office if anything is unclear or appears incorrect.
HOW TO PAY
• Online: payment_portal_url (secure, 24/7)
• Phone: me::phone (billing office hours are Monday–Friday, 8 AM to 5 PM)
• Mail: Check payable to our practice — address is listed on the attached statement
FINANCIAL ASSISTANCE
• payment_plan_note
• If you are experiencing financial hardship, please ask about our charity care program when you call — we are committed to ensuring access to care for all patients regardless of financial circumstances
INSURANCE QUESTIONS
If you believe your insurance should have covered a portion of this balance that it did not, please contact your insurance company directly with the Explanation of Benefits (EOB) they should have sent you. Our billing team is also available to assist.
Thank you for trusting us with your care. Call me::phone with any billing questions.
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