Request for a prompt-pay or self-pay discount

Here is a letter asking for a prompt-pay or self-pay discount, or a payment plan if a discount is not possible. Fill in the bracketed parts and send it yourself.

Use it when you want to settle the bill and ask for a lower amount or a payment plan. · Checked 28 September 2026

The letter

This is the draft Med Bill Check writes. On the home page you can add your details and, for a review letter, the code and amount, and it fills them in. Anything in [brackets] is for you to complete.

[Your full name]
[Your address]
[Your phone or email]
[Today's date]

Billing Department
[Provider or hospital name]
[Provider address]

Re: Account number [account number], date of service [date of service], patient [patient name]

Dear Billing Department,

I would like to settle the balance on the account above. [If you are paying without insurance, say so here.]

Could you tell me whether you offer a prompt-pay or self-pay discount if I pay in full, or a lower rate such as your posted discounted cash price? Hospitals publish their standard charges, including discounted cash prices, under federal price transparency rules. If a discount is not possible, I would welcome an interest-free payment plan.

Please confirm any agreed amount in writing before I pay.

Thank you for your help. I look forward to hearing from you.

Sincerely,
[Your name]

Tips

• Ask on the phone first, then confirm the agreed amount in writing.
• Hospitals post discounted cash prices online, so you can check theirs.
• Ask whether you qualify for financial assistance too. It can reduce the bill further.

If you are paying without insurance

For self-pay, the letter says:

I would like to settle the balance on the account above. I am paying for this care myself without insurance.

Your rights

• No Surprises Act. Since 2022, most people with health insurance are protected from surprise bills for most emergency care, for out-of-network providers at in-network hospitals and surgery centers, and for air ambulances. You should only owe your in-network cost sharing. Official page
• Good Faith Estimate. If you are uninsured or not using insurance, providers must usually give you a Good Faith Estimate when you book care at least 3 business days ahead, or when you ask for one. Official page
• Bill above your estimate. If a provider bills at least $400 more than its Good Faith Estimate, you may be able to use the federal patient-provider dispute process. Start within 120 calendar days of the date on the bill. The fee is $25. Official page
• Free help. The No Surprises Help Desk answers questions about these rights on 1-800-985-3059. Official page

Other letters

• Request for an itemized bill
• Request to review a charge
• Request for financial assistance (charity care)

Sources

• https://www.cms.gov/nosurprises
• https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6
• https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency

This is a draft for you to review, edit and send yourself. It is general information, not legal, medical or financial advice. Med Bill Check never sends anything for you.