Request To Patient For Insurance Payment Mailed To Them

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


Patient Name
City, State  Zip

Dear ______:

I have just spoken to [insurance contact's name] at [insurance company]. She informs me that checks have been sent to you in payment for your services on [dates of service].  These checks are made out to both you and Dr ________.  If you could endorse them, and forward them to us, we would appreciate it. We can then credit your account, and clear your claims out of the system.  Payment of the balance owed after insurance, $[xxx.xx] would also be appreciated.

If you have any questions, please do not hesitate to call me.



Jane Doe
Financial Coordinator for Dr. _______