DATE

 

Patient Name

Address

Spokane WA zip

 

 

Dear XXXXX,

 

Analysis of your account shows that you made a personal payment prior to an insurance payment and a contractual insurance adjustment.  This has resulted in a credit balance.

 

Enclosed please find a check in the amount of $[xxx.xx].     

 

 

 

Sincerely,

 

 

 

 

Jane Doe

Financial Coordinator for

Dr. Randy Otterholt