Medical Debt Validation Letter Template

You can open the Medical Debt Validation Letter Template in multiple formats, including PDF, Word, and Google Docs.

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Medical Debt Validation Letter Template

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Medical Debt Validation Letter Template (1)
From:
[Your Name]
[Your Address]
[City, State, Zip Code]
[Your Phone Number]
[Your Email]
To:
[Creditor’s Name]
[Creditor’s Address]
[City, State, Zip Code]
Date:
[Date]
Subject:
Request for Debt Validation
Dear [Creditor’s Name],
Introduction:
This letter serves as a formal request for validation of a medical debt that you claim I owe. According to the Fair Debt Collection Practices Act (FDCPA), I have the right to request verification of the debt in question.
Details of the Debt:
I am writing regarding the account number [Account Number] related to a medical service provided on [Date of Service]. Please include verification of the debt along with any necessary documentation that substantiates the amount claimed.
Request for Documentation:
I request the following documentation:
1. Proof of the debt, including the original creditor’s name and account number.
2. A detailed statement of how the debt amount was calculated.
3. Any applicable contracts or agreements that authorize the collection of this debt.
Time Frame for Response:
Please provide the requested documentation within 30 days of receipt of this letter to avoid any unnecessary actions related to this account.
Conclusion:
I appreciate your prompt attention to this matter. Please respond to the address provided above. Thank you.
Sincerely,
[Your Signature]
[Your Printed Name]
Medical Debt Validation Letter Template (2)
From:
[Your Full Name]
[Your Address Line 1]
[Your Address Line 2]
[Your City, State, Zip Code]
To:
[Healthcare Provider’s Name]
[Healthcare Provider’s Address Line 1]
[Healthcare Provider’s Address Line 2]
Date:
[Date]
Subject:
Medical Debt Validation Request
Dear [Healthcare Provider’s Name],
Introduction:
I am writing to formally request validation of a medical debt that your office has indicated I owe. Under the Fair Debt Collection Practices Act, I am entitled to verify this debt before making any payments.
Debt Information:
The medical debt in question pertains to account number [Account Number] and services rendered on [Date of Service]. I would like to request the details regarding this alleged debt.
Validation Requirements:
Please provide the following information:
1. The original amount of the debt and itemized details.
2. Validation of the legitimacy of the debt, including the original creditor.
3. Any documentation that proves that I am liable for this debt.
Response Timeline:
I kindly ask you to respond to this request within 30 days from the date of this letter to ensure all communications regarding this matter are complete.
Closing Statement:
Thank you for your cooperation. I look forward to receiving a prompt response regarding this request.
Sincerely,
[Your Signature]
[Your Printed Name]

Template Online

Format

Please complete the form below to create the Medical Debt Validation Letter Template. All fields must be filled out to ensure a clear and complete letter. We provide examples to guide you through each step.

Medical Debt Validation Letter Template

1. Debtor Information


2. Creditor Information


3. Account Information

4. Request for Validation

5. Proof of Debt

6. Legal Rights Information

7. Payment Options

8. Date of Submission

9. Signature Section


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Medical Debt Validation Letter Template

Printable | Editable Form

PDF 1 PDF 2

Medical Debt Validation Letter Template