Takes 3 minutes. A few quick questions about your birth.
All taps — no typing yet.
The itemized bill lists every charge individually — this is what we need to find errors
Your letters arrive in your inbox the moment you pay.
Select everything you see on your bill — or anything that might be on it. Not sure? Select it anyway. We'll help you verify.
December 18, 2025
Patient Financial Services
Memorial Medical Center · Billing Department
Your State 00000
Re: Formal Notice of Billing Dispute — Maternity Account
Dear Patient Financial Services Representative,
I am writing to formally dispute multiple charges on my maternity billing statement. After carefully reviewing my itemized bill, I have identified several line items that appear to be incorrectly billed, duplicated, or not reflective of services actually rendered during my hospital stay.
Pursuant to the No Surprises Act (26 U.S.C. § 9816) and applicable state balance-billing protections, I respectfully request a full review and written response within 30 days of receipt of this letter.
Based on your answers, here are the specific problems we identified on your bill — and what we'll build to help you fight them.
Your appeal packet arrives in your inbox the moment you pay.
"Worth every cent. Got my packet in 2 minutes, sent the letter the next morning, had a resolution in 3 weeks."
Your personalized appeal packet was built and downloaded directly to your device — check your Downloads folder now. An email copy is also on its way to your inbox shortly.