Date of Service: [Click here and type date] Amount Due: [Click here and type amount due] Dear: [Click here and enter name] We have made every reasonable effort to obtain payment for the services you received from this practice, but despite those efforts; payment has not been released by [Click here and type name], who is responsible for the administration of your health benefits offered by your employer [Click here and type employer name]. Therefore, you are fully and completely liable for this bill for services provided to you. This office cannot become involved with the internal bureaucracies of your employer or of [Click here and type third party adminstrator] (TPA), whether this delay is intentional or by error. Please realize that often [Click here and type third party adminstrator] (TPA) uses a variety of excuses to delay payments to physicians, increasing the administrative costs to the physician, and increasing the cost of healthcare for people. This failure to release payment may be in direct violation of Title 29 of the United States Code of Federal Regulations, as section 2560.501-1(f)(2)(iii) requires timely notice and processing of medical claims. You should speak with your employer’s representative about this issue. However, it is your responsibility to make payment for the services you received, as agreed when completing the registration materials in my office. You are therefore asked to make payment of this bill directly to my office at this time. You should also protect your rights to your health insurance benefits with you employer. And if unsuccessful; in obtaining coverage from your employer, you may wish to seek the assistance of both State and Federal regulators. New York State Attorney General, Health Care Bureau Hotline (800) NY AG HCB (800) 682-4422 US Department of Labor http://www.dol.gov/ebsa/ I am sorry to involve you in t his matter. It would have been my preference to resolve this financial matter directly with (health plan name) as agent for your employer. Be assured that I continue to be concerned for your medical care, and remain available should the need arise. Sincerely,
cc: [Click here and type employer]
Practice Intolerance