Generate Your Letter
Fill in the details below and choose who you are writing to. This tool will build a letter you can copy into an email, upload to a portal, or print and mail.
This tool does not provide legal advice. Review the letter before sending and adjust the language to fit your situation and any requirements from your insurer, provider, or state regulator.
Your Letter (Copy / Edit as Needed)
You can select all, copy, and paste this text into an email, a secure message portal, or a document to print and mail. The Print / Save as PDF button opens a clean print view, and Download .TXT saves the letter as a text file.
How to Send This Letter
These are general tips, not legal advice. Adjust for your situation and your states rules.
Email vs. Mail vs. Portal
Many insurers and providers now accept documents by secure online portal, email, or postal mail. If possible, use whatever method they recommend for disputes or appeals.
- Portal: Upload the letter as a PDF or text file and keep a screenshot of the upload confirmation.
- Email: Send as plain text or attach the TXT or PDF file. Save a copy of the sent message.
- Mail: Print the letter and consider using tracking or certified mail for important disputes.
Subject Line Suggestions
- Provider dispute: Dispute of Ambulance Balance Bill – [Date of Service]
- Insurance appeal: Appeal of Ambulance Claim – [Date of Service], [Claim #]
- Regulator complaint: Complaint – Ambulance Balance Billing – [Your City/State]
What to Attach
- A copy of the ambulance bill.
- Your Explanation of Benefits (EOB) from the insurer, if available.
- Any prior letters or emails you have already sent.
- Notes of phone calls, including dates, names, and what was said.
Black out sensitive numbers, such as full account or ID numbers, if you are concerned about privacy when emailing.
Follow-Up and Timelines
- Ask your insurer how long an appeal decision usually takes, often 30 to 60 days.
- Set a reminder to follow up if you have not received a response.
- If you receive collection letters while an appeal or dispute is open, keep copies and mention that in any complaint to regulators.
Keep Copies of Everything
- Save a copy of each letter you send.
- Keep upload confirmations or mail receipts in the same folder.
- Write down each step you take; this helps if you later file a state complaint.
What to Say If You Call
If you prefer to call instead of only sending a letter, you can use simple language and then follow up in writing.
When calling the ambulance provider:
"I received an ambulance bill for emergency services on [date]. I am calling to dispute the amount. Under AB 716, emergency ground ambulance providers cannot balance bill patients beyond in-network cost sharing. I am requesting an itemized bill and a written response. Please note my dispute on the account."
When calling the insurance company:
"I am calling about my ambulance claim for services on [date]. I would like to file an appeal or request a reconsideration. Can you confirm the appeal is open and provide the expected timeline for a decision?"
When calling a state regulator:
"I want to file a complaint about an ambulance bill and how the claim was handled. Can you tell me where to submit the complaint and what information you need?"
Write down the date, time, and name of anyone you talk to. Follow up with a written letter, email, or complaint form.
What to Say If You Call
If you prefer to call instead of only sending a letter, you can use simple language like this and then follow up in writing.
When calling the ambulance provider:
"I received an emergency ground ambulance bill for services on [date]. I am calling to dispute the amount. Under California AB 716, emergency ground ambulance providers cannot balance bill patients beyond their in-network cost sharing. Please note my dispute on the account and send me an itemized bill and a written response."
When calling the insurance company:
"I am calling about an ambulance claim for services on [date]. I would like to file an appeal and ask that you reconsider the allowed amount. Please confirm that an appeal has been opened and tell me how long a decision will take."
When calling a state regulator:
"I would like to file a complaint about an ambulance bill and how the claim was handled. Can you tell me how to submit my complaint and what information you need from me?"
Write down the date, time, and name of anyone you speak with. Follow up with a written letter, email, or online complaint whenever possible.
How to Send This Letter
These are general tips, not legal advice. Adjust for your situation and your states rules.
Email vs. Mail vs. Portal
Many insurers and providers now accept documents by secure online portal, email, or postal mail. If possible, use whatever method they recommend for disputes or appeals.
- Portal: Upload the letter as a PDF or text file and keep a screenshot of the upload confirmation.
- Email: Send as plain text or attach the TXT or PDF file. Save a copy of the sent message.
- Mail: Print the letter and consider using tracking or certified mail for important disputes.
Subject Line Suggestions
- Provider dispute: Dispute of Ambulance Balance Bill – [Date of Service]
- Insurance appeal: Appeal of Ambulance Claim – [Date of Service], [Claim #]
- Regulator complaint: Complaint – Ambulance Balance Billing – [Your City/State]
What to Attach
- A copy of the ambulance bill.
- Your Explanation of Benefits (EOB) from the insurer, if available.
- Any prior letters or emails you have already sent.
- Notes of phone calls, including dates, names, and what was said.
Black out sensitive numbers, such as full account or ID numbers, if you are concerned about privacy when emailing.
Follow-Up and Timelines
- Ask your insurer how long an appeal decision usually takes, often 30 to 60 days.
- Set a reminder to follow up if you have not received a response.
- If you receive collection letters while an appeal or dispute is open, keep copies and mention that in any complaint to regulators.
Keep Copies of Everything
- Save a copy of each letter you send.
- Keep upload confirmations or mail receipts in the same folder.
- Write down each step you take; this helps if you later file a state complaint.
What to Say If You Call
If you prefer to call first and then follow up in writing, these are simple examples of what you might say. Adjust the wording to fit your situation.
Calling the Ambulance Provider
"I received an ambulance bill for emergency services on [date]. I am calling to dispute the amount. My understanding is that emergency ground ambulance providers cannot balance bill patients beyond in-network cost sharing. I am requesting an itemized bill and a written response. Please note my dispute on the account and pause any collection activity while this is reviewed."
Calling the Insurance Company
"I am calling about an ambulance claim for services on [date]. I would like to file an appeal or request a reconsideration of the allowed amount. Can you confirm that an appeal has been opened and tell me the timeline for a decision? I would also like instructions for submitting any supporting documents in writing."
Calling a State Regulator
"I want to file a complaint about an ambulance bill and how the claim was handled. Can you tell me where to submit the complaint and what information you need from me, such as copies of the bill, explanation of benefits, or prior correspondence?"
After any phone call, write down the date, time, and the name of the person you spoke with, and follow up with a letter, email, or online complaint form.
Example Letters
These sample letters show what a completed message looks like. Feel free to copy useful lines, but make sure to customize your own letter with your specific details.
Example Provider Dispute Letter
[Your Name]
[City, State]
[Date]
[Ambulance Provider Name]
RE: Dispute of Ambulance Balance Bill – [Date of Service]
To whom it may concern,
I am writing to dispute the ambulance balance bill issued for services provided on [Date of Service]. The amount billed or remaining balance is [Dollar Amount]. I am requesting a detailed review of these charges and a pause on any collection activity while the review is conducted.
Please provide:
• A complete itemized bill with all codes and charges listed.
• An explanation of how the billed amount was calculated.
• Clarification on whether this service is considered in-network or out-of-network.
My insurer for this claim is [Insurance Company], Policy ID [Policy ID], Claim #[Claim Number].
Thank you for reviewing this matter. I look forward to a written response.
Sincerely,
[Your Name]
Example Insurance Appeal Letter
[Your Name]
[City, State]
[Date]
Appeals Department
[Insurance Company]
RE: Appeal of Ambulance Claim – [Date of Service], Claim #[Claim Number]
To the Appeals Department,
I am appealing the payment determination for ambulance services received on [Date of Service]. The provider for this claim is [Ambulance Provider], and the billed or remaining balance is [Dollar Amount].
I believe the current reimbursement does not reasonably reflect the emergency nature of the service. I request reconsideration of the allowed amount and a written explanation of your findings.
Please review:
• Whether emergency ground ambulance services should be treated as in-network.
• Any applicable internal policies, exceptions, or state regulations.
• Whether adjustment or negotiation with the provider is appropriate.
Thank you for your attention to this appeal. Please confirm when it has been opened and provide the expected timeline for a decision.
Sincerely,
[Your Name]
Example Regulator Complaint Letter
[Your Name]
[City, State]
[Date]
[State Department of Insurance / Consumer Protection Office]
RE: Complaint Regarding Ambulance Billing – [Date of Service]
To whom it may concern,
I am filing a complaint regarding an ambulance balance bill I received for services on [Date of Service]. The ambulance provider is [Ambulance Provider], and the billed or remaining balance is [Dollar Amount]. My insurer is [Insurance Company].
I have attempted to resolve this issue by disputing the bill with the provider and submitting an appeal to my insurance company. Despite these efforts, I believe the charges and/or claim handling are unfair or inconsistent with consumer protections.
I am requesting a review and any guidance on available remedies or next steps.
Sincerely,
[Your Name]
Find Your State Regulator
Many states allow you to file a complaint about ambulance billing with a state regulator, often the department of insurance or attorney general. This tool gives you search phrases you can use to find the official complaint page for your state.
Select your state to see suggestions for who to contact.