Hardship Letter to Hospital

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

{Hospital Name}
{Address}
{Phone Number}
ATTN: {contact person}

{Date}

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 name} on {date}, where I received{a specific procedure, treatment, etc.}. My insurance covered {amount in dollars}, which left a balance of{amount in dollars} for me to deal with myself. { Or note that you did not have insurance at the time of this incident}.

I worked out a payment plan of {amount in dollars} per month, which I have been paying since {date}. However, due to {death in the family, loss of a job, other medical problems, etc.; be specific and emotional}, I am struggling greatly with making ends meet every 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 you.

I am now only able to pay {amount in dollars} every month {or indicate that you would like to have your debt forgiven due to this hardship}. I know that the hospital has programs in place for situations like mine, and I hope that we can work out a plan that will satisfy both of us.

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

Sincerely,

{Sender Name}

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