Sample Hardship Letters  

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Medical Hardship Letter

If you have accumulated unexpected or overwhelming medical bills and your current financial situation does not allow you to pay those bills, then consider submitting a hardship letter to request relief.

Below are two sample hardship letters for medical bills:



[Billing Department Address]

RE: [Date(s)] in the hospital or of medical procedure

Dear Sir or Madam,

With this letter, I would like to state my inability to pay the bill for amount of [Amount Owed] for the procedure performed on the [Date] [or my hospital stay from [Date] to [Date]]. Please understand that this is neither a refusal to pay nor a dispute of the charges, but simply an explanation of my current financial situation.

My current income is just enough to cover basic necessities. By paying the amount due all at once as required, It would result in a serious financial hardship for my family. Please understand that I want to pay for the medical services performed and my stay in the hospital. I would like to propose paying the entire amount in monthly installments for the next [number of months] months [or you can suggest to pay a percentage of the bill at once and the rest at a later date].

I hope you will consider this request and agree to a more flexible payment. Thank You very for your understanding. If you have any questions, please call me at [Your Phone Number].


[Your signature]

[Your Name, Address, Phone Number, and Social Security # ]

{Your Name}
{Your Address}
{Your Phone Number}

And here’s another example …

{Hospital/Clinic/Doctor Name}
{Phone Number}
ATTN: {contact person}

RE: {consolidation/restructuring/forgiveness} of debt on medical bills for
{Name}, account {number}

To Whom It May Concern:

My name is {Name}, and I was a patient at {hospital/clinic/doctor’s office} on
{date}, where I received {a specific procedure, treatment, etc.}. {Indicate
what your insurance covered of this procedure, or note that you did not
have insurance at the time}.

I have been on a payment plan that has me paying {amount in dollars} per
month. But I have unfortunately run into significant troubles in my life, which have
made it impossible for me to continue to keep up with this payment plan. Due to
{death in the family, loss of a job, other medical problems, etc.}, I am
dealing with making constant decisions about which of my many bills is most
important each month.

I have attached {relevant financial documents} to this letter, so that you can
see that my monthly income is only {amount in dollars}, all of which must go to
{mortgage, rent, other payments}, leaving very little left for the amount I owe

{Indicate how much you can pay each month, or indicate that you would
like to have your debt forgiven due to this hardship}. I hope that we can work
out a plan that will work for both parties.

Please contact me as soon as possible so that we can begin this process.


{Sender Name}