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Hardship Letter Template For Medical Bills

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    A medical hardship letter is written to express one’s inability to settle current medical expenses due to various reasons such as financial difficulties.

    1. Identity

    The requester should give his or her personal details including the name, the contact information and the social security number if possible. The requester may also include the account and reference number, the health institution, not forgetting the date of the medical procedure.

    2. Explanation

    The requester states clearly that he or she is not able to pay the bill on time as expected and should show willingness to do so.

    3. The Hardship

    The requester gives the main reasons why he or she is not able to settle the bill on time as expected and explain if the situation is temporary or permanent for clarity and future reference.

    4. Proposal

    The requester should propose the right methods of payment according to his or her financial capabilities. This includes reduction of the monthly installments to a particular rate.

    The following hardship letter for medical bills template is suitable for all requester.

    How To Write A Hardship Letter For Medical Bills

    January 5, 2012

    Bill Dates Kenny Road,
    Ontario 95735

    Well Being Clinic Ellington,
    Cleverly 495750

    RE: Letter Of Extreme Medical Hardship

    Dear Sir/Madam,

    I am writing this letter to explain my unfortunate financial condition that has led to my inability to pay the medical bill for my respiratory treatment that took place on 12/12/2011 at your facilities. I acknowledge that it is my responsibility to settle the bill but these unfortunate circumstances have distracted my initial plans to settle the full payments.

    Due to the sensitive nature of my health condition, the doctors suggest that I should take a bed rest for three months because back at the workplace, I am always exposed to dust and a chilly environment which is harmful for this condition.

    I have taken an official leave for three months. During this period, my daily source of income has been interrupted and I am now forced to survive on tight budgets for me and my family.

    For these three months, I propose that I pay the bill in simple installments of not more than $100 per month. I hope to resume work very soon and settle the remaining amount quickly. I am hoping for a favorable reply from you.

    Yours Faithfully,


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