Doctor Cash Payment Request

{Your Name}
{Your Address}
{Your Phone #}

{Date}

Dear {Doctor}:

I am looking to make an appointment with your office in order to {description of requested procedure}. However, this procedure is not covered by my insurance policy. I understand that these procedures generally run {amount}, and I would like to request a discount for the use of cash payment.

I am at this time unable to pay the full amount for this procedure, especially as it is not covered by my policy. If you reduced the cost to {amount}, or roughly 50% of the normal cost, I would be able to pay up front with cash. I understand that this would cut down on billing work and filing time for your office, so I think it would benefit both of us.

I will contact your office next week to set up my appointment. I hope at that time to speak to someone on your staff about this possibility.

Thank you,

{Sender Name}

Index of Hardship Letter Examples