Patient Sample Letters The Council on Dental Benefit Programs has developed two sets of sample letters to help address problematic language found in a patient's explanation of benefits (EOB) statements. Allergy Warning Labels. You will still want to monitor these accounts. Comprehensive Doctor’s Note to Return to Work Writing a refund letter can be tricky, but it is a task that all should know how to do. In addition to the free information shared in blog posts and the library, you will find resources and services you may purchase to help with your dental practice growth and expansion. A patient might call requesting a refund after the check was sent. Details of Sample Letter from Doctor. Following this monthly procedure will build patient trust. Download the sample letter (MS Word) Additional resources. letter) while you have an opportunity to arrange for another. You can even find patients who might have paid for dental treatment in advance and haven’t returned for treatment. Thank you for being patient with us and be assured that we value you as one of our top customers. Dear Mr. XYZ, ABC Bank, This will clean up your credit balance report without having small amounts of .40 or so carrying over into another month. It won’t be often that you will see this happen. Apology for Incorrect Payment Overpayment – [Name, Company Name & Address here] [Date] Dear [name], During our last audit, we found that we have made a wrong payment to your firm through check no. %PDF-1.4 Dear Mr. XYZ, ABC Bank, The purpose of the letter and medical treatment authorization. Sensory Recording Sample Form - NEW. We are doing the best that we can to fix the problems, and assure you that you will receive your refund amount of _____ (the refund amount) latest by _____ (mention the most recent date by which the refund would be received). You certainly don’t want money kept on an account that later has to be sent to the state as unclaimed property. It clarifies that patient will not publicize a complaint in the media including social media, internet communications, blogging, etc. I was not able to catch that flight as I was not well. Outstanding Patient Account Balance Letter Template letter to patients/families alerting them of an outstanding patient account balance. That's why I have taken all the personal, professional, and educational training I've experienced and brought it here to share with you. This has resulted in a credit balance on your account. Payment Related Letters Template letters notifying fami lies about a practice’s financial policies, outstanding balances, questions about bills, co-payments, etc. After that, it includes treatment and few procedures that have been implemented. Hopefully, you are working with a software system that allows you to set up several types of billing cycles. If there's something you are looking for, but can't seem to find, I'm here for you! emergency basis only, until (date at least 30 days from the date of. Sample Orthodontic Forms. A refund/waiver of professional fees in the amount of $ has <> letter) while you have an opportunity to arrange for another. This will be very meaningful to a doctor. 2) That the agreement to refund is not an admission of liability; and 3) That the patient agrees not bring any civil action against the doctor for the orthodontic treatment. A quick letter will provide explanation and reassurance to your patient. I’ve seen a few nightmares become reality when this hasn’t happened. Healthcare professionals are human and like the rest of us, spend most of their time at work, so it's only inevitably that mistakes of some kind will be made from time to time, … It is very important that the letter be sent within any deadline. Sample Referral Letter. A letter of intent to return to work is written by an employee to let an employer know that they’re ready to return to work after a period of sickness, surgery, or injury. Running monthly credit balance reports are essential. The patient has the right to any healthcare benefits they pay for or get through their job. A refund refusal letter sample for the explanation paragraph could be: We take great care to provide our customers with linens* that will serve them well for many years. F]�)z�x�w��x��̷b�. Sample Re-Schedule Appointment Letter. Then apologize for the patient’s experience. Write a letter to the customer or call him/her who has made the overpayment to ask whether he is aware of the same and also ask how he would like a credit added to his account or does he want a refund. Create a separate billing cycle for these credit balances. What if the credit balance is incorrect? 3 0 obj I recommend doing a debit adjustment for any credit which is $3.00  or less. Sample Patient Test Results Letter. This may include bills and receipts or letters from the doctor or medical technician proving that treatment was required by a qualified physician. I am writing this letter so that if it is possible please refund my money as I did not catch the flight. Thank you for your most recent payment of $100. This sample letter can be personalized for your practice as you communicate details of reopening amid COVID-19 to your patient population. My name is (Your name) and I booked the flight to (City/Country name) last week (Date). could jeopardize your health, so please act promptly. Sample Patient Test Results Letter. Sample 1 - Refund Request Letter Willard Smith 3806 Jisco West Rd Jackson, Ohio 45640 DATE Worldwide Pan Company 7800 Sana Monica Lane Beverly Hills, CA 90210 Subject: Defective Pans Refund To Whom It May Concern: I bought a pot and pan set with a lifetime warranty from your company at our local department store. I will remain available to provide medical treatment to you, on an. People typically use this letter to ask a refund for a broken product, paid tuition fee from previous schools, or the amount of money borrowed from them. It will also keep your accounts clean. and the acceptance of the offer, should be noted in the patient’s record. File a copy of the letter and the receipt in the patient’s medical record. Dr. Otterholt's Free Dental Consultant Letters & Forms 800-595-2380 E-Newsletter Blog But it’s best to pick a date and make it part of your routine. Sample Referral Reply Letter. 4 0 obj Start with the smaller credit balances first. Implicit or explicit in the letter is the understanding that failure to tender a refund will lead to an eventual lawsuit. The discharge letter should be marked "personal/confidential" and mailed by certified mail, return receipt requested, to the patient’s last known address. And you can also register to receive blog posts sent directly to your email inbox! Make sure the refund letter is scanned to the patient account. Dear ____: Analysis of your account shows that you made a personal payment prior to an insurance payment and a contractual insurance adjustment. 6 0 obj Begin the account audit from where the ledger reads $0. At times, the adjustments can be a little tricky to understand. Here is a sample medical insurance claim letter. Sincerely, Jane Doe Financial Coordinator for Dr._____ Each document should be directly relevant to the treatment received. For example, a diagnosis of “fatigue, bone pain or weakness” is not specific –a diagnosis Notification of Practice’s Financial Policies Template letter notifying patients/families with insurance that includes high out-of-pocket expenses (deductibles and co-pays) about the practice’s financial policies.. Comments. When a customer contacts you wanting a refund for a purchase, it can be an awkward experience.. This sample is so basic that it can be filled without any effort. In fact, I have worked with patients who have paid faithfully every month into their dental office account. Any patient who is prepaying for dental treatment, should have their account placed in this cycle. Send dental patient refund letters with every patient refund check. The first set is designed to be sent to third-party payers and the second set is designed to be sent to employers. When someone wants to confirm his illness or medical reports this was written by a patient or doctor to confirm these. There may be things hidden in this report you need to know. If a patient misses an appointment, then they may be offered a chance to reschedule this. Sometimes, the patient also demands additional money so that she can pay for a second round of surgery elsewhere. Several weeks later, the physician receives a letter from the patient, who demands a refund. This “Sample Letter From Doctor Confirming Illness” is written when a doctor wants to confirm illness from his patient.These letters consider special skills of the person. Download Customizable letter word icon [DOC – 1 page] This sample letter tells patients their test results were negative. Sensory Recording Sample Form - NEW. If you find a valid credit balance on an account where a patient hasn’t been in for six months, call them first! If the letter is returned unclaimed, mail ... A sample discharge letter is included here for reference on page 4. physician. Dental Patient Refund Letter #1:  To Use When A Patient Has Overpaid Their Co-pay  Dental Patient Refund Letters, Dental Patient Refund Letter #2:  To Use When A Patient Has Pre-Paid For Dental Treatment  Dental Patient Overpayment Refund. The common concern of either the company or physician in issuing the return-to-work note is finding a sample that is easy to customize, fill out, and print. It can also be a great learning experience for any new dental front office team member. The credit balance report will show you many things. In my e-book, Weekly Management Systems,  I designate the last Tuesday of each month. The last thing you want to do is blindly send out refund checks to every patient on your report. Share This! That way it won’t ever be forgotten. Then apologize for the patient’s experience. You continued collecting payments after the patient exceeded his or her annual deductible or out-of … Write this type of letter when you are communicating with the letter recipient about a returned check, such as when a customer paid you with a check and the check was returned unpaid due to insufficient funds. A detailed history of past medical complications of the patient along with all reports. ��G�x��`̊Vzt03��+F����2*� Gx���wƞ�I�g�Ur���]p�E���::�: �2��J}u��aΛ�1ȁ��,-�` ��1����2�L��&L������bT�{�AX��%�Rc�B��5��NL�p�u�=�#��V�qbvsD�ϞVu�SL���C��*~e)�K���ɻ�+UWG{ڥ�K�\�aGi먝����x$��e��suv��V�� Complimentary Sample Dental Office Letters to Dentists, Patients and Others. You’ll be so glad you did the work! Apology Letter to Patient – 5+ Sample Letters. First, open your letter with a courteous and professional salutation. Designate a specific date and time to run your credit balance report. /Contents 4 0 R>> Below is a sample of a suitable note: “After several conversations and attempts at remediation, we have not been able to fully satisfy with the results of treatment. Subject : (mention the refund of the particular product) Dear Sir/Ma’am/ (the person who may be responsible for processing the refund), This is to bring to your kind notice that I had recently ordered a (product) from (company name, store name or the e commerce site). This will keep your ledger and accounting systems so much cleaner. Sample Letter to Patient – Swallowed or Aspirated Object - NEW. Example letters to inform a customer of an overpayment. Your company advertises a “100% Satisfaction Guarantee” for customers, printed on the promotional postcard that was sent to my home. This is why it is great to run this report near the end of each month before you close the month! It is a formal letter written by the company to the customer or sometimes addressed by the customers to the company. admin. 4. This post may contain affiliate links that at no additional cost to you, I may earn a small commission. If you are practice owner or practice manager, you want to see this report every month. Follow down through the ledger, double checking all of the individual charges, insurance payments, patient payments, and adjustments. *Disclosure: I only recommend products I would use myself and all opinions expressed here are my own. Document this conversation as well and date stamp. Additional support may be necessary in calculating  patient co-pays or treatment presentation. Facebook Twitter Pinterest Email. I have also worked with patients who have prepaid for extensive treatment or surgical procedures over a series of months. After that, it includes treatment and few procedures that have been implemented. Sample Referral Letter. I will remain available to provide medical treatment to you, on an. Introduction (generally only a few … Sub: Letter to Airline Official for Refund Due to Sickness. Allergy Warning Labels. Patient Complaint Letter Response Structure . The main purpose of refusal letters is to notify the recipients of your decision to decline. It doesn’t have to be this day for you. Customer of a Returned Check; (2) Letter to Advise Customer of a Returned Check (1st Occurrence); (3) Letter to Advise Customer of a Returned Check (2nd Occurrence); and (4) Letter re: Returned Check, 3rd Notice – Collection Warning This first form is designed to assist you in drafting a series of letters to a United States of America. Next, explain the purpose of your letter, referencing the concerns they shared in their complaint letter. There is a great responsibility of prescribing a medicine or losing a life in the devastating incident. If this is the case, the patient should be sure to keep copies of everything. Any delay. Letter to Advise Customer of a Returned Check (2nd Occurrence) 4. For example, if patient co-pays are frequently miscalculated, you will find that here. Our goal is always to balance what it costs us to make a product with the useful life we expect it to have. But because medical conditions differ from patient to patient, the template provided contains placeholders to make it easy for you to personalize each note. This letter contains a doctor letter for a patient with disabilities. In this note, the doctor certifies that the employee is under his professional care and he does not deem the employee medically fit for traveling. An apology letter to patient is written by a doctor to a patient to express regret for a mistake. emergency basis only, until (date at least 30 days from the date of. Negotiate the amount of the refund. Add a subject line to acknowledge that you received the complaint. If you haven’t closed your month yet, this is much easier to do. Can Save Your Dental Practice Time And Money! Pennsylvania. Guidelines for Writing Letters to Patients 403 Table I. Next, explain the purpose of your letter, referencing the concerns they shared in their complaint letter. This will give your office time to make any necessary changes with ease. Enclosed please find a check in the amount of $[xxx.xx]. They have done this as their own dental savings account. Make any necessary corrections or adjustments. Complimentary sample dental office letters to dentists, physicians and patients. here] . This “Sample Letter From Doctor Confirming Illness” is written when a doctor wants to confirm illness from his patient.These letters consider special skills of the person. Patient Complaint Letter Response Structure . This will ensure that every patient who enters the clinic is attended to by making it efficient for doctors to fill and sign these notes. You might be happy to learn that at the time of this payment your balance was only $27.55, leaving a $72.45 overpayment. Sample – Refund Demand Letter. A reimbursement letter for medical expenses may be required if an individual’s doctor or other healthcare provider did not submit the required documents for a claim to the individual’s health insurance company. If at all possible, try not to close your month until dental patient refund letters are completed for that month. Letter to Advise Customer of a Returned Check (1st Occurrence) 3. But helps offset costs to maintain this website. Any delay. It is a simple but comprehensive letter containing all the necessary details related to a patient’s physical disability. Patient Name Patient Address City, State Zip. Blue Airlines. Perform this audit each and every month on the same day of the month. I’m here for you! Unless your patient has transferred care or left the practice for some reason. December 12, 2018. As you can see from the enclosed withdrawal slip, I am within that limit. <> This content is for use within the state of New Jersey. And a refund letter also reduces the amount of phone calls coming into the dental office. First, open your letter with a courteous and professional salutation. Download Customizable letter word icon [DOC – 1 page] This sample letter tells patients their test results were negative. Just a letter from a lawyer can motivate a dentist to action, or you can go to a full-blown lawsuit. refund letters to the lawyer. Add a subject line to acknowledge that you received the complaint. ... Now I am requesting a refund for the crowns that I paid for and never got but am getting grief from the dental office about a retraction on my insurance and the refund. If a patient misses an appointment, then they may be offered a chance to reschedule this. In both cases it is a formal way to ask to pay the outstanding payment politely. MGMA COVID-19 Action Center — Regulatory and legislative updates from MGMA … Or it might be the check never gets cashed at all. 5. Sample request letter to refund payments from supplier, clients, lawyer, vendor or from school, college and university. Simply ask them if they would like this money returned or kept on account. The letter can also be used to remind them that they should cancel any appointments that they are unable to attend so that it can be offered to another patient. https://asthedrillturns.com/2019/02/27/dental-patient-refund-letters-download If this happens, the claimant may be able to resolve the issue with a claim letter. A refund request letter can be used for all sorts of reasons. You can use this letter for any kind of payment return like membership fee etc. To, The Authority. 5 0 obj endobj There can be many reasons why a patient is writing a letter to a doctor. Enter your email address to subscribe to this blog and receive notifications of new posts by email. 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