Medical Billing Patient Communication Templates

What’s included in these templates

All five are free downloads — three editable Word documents and two PDF handouts. Each one downloads directly.

Before you send anything: these templates are laid out on a sample practice letterhead. The practice name, address, phone number and email address in the files are placeholder details for a made-up practice, not real contact information. Replace every one of them with your own practice details before giving a document to a patient.

Patient Balance Due Letter

a first-notice balance letter with fields for date, account number, date of service and insurance plan, and an account summary covering total charges, insurance payment, adjustments and write-offs, previous payments, and the amount now owed

Explanation of Benefits (EOB) Guide

a patient handout that reads an EOB line by line — member and policy ID, date of service, the CPT code and service description, in-network versus out-of-network, and the out-of-pocket maximum — then covers common problems and the right to appeal, with appeal windows usually 60 to 180 days from the denial date

Insurance Denial Patient Letter

a notice with fields for the claim reference and denial reason code, an explanation of what a denial means, and a table of common reasons: not medically necessary, prior authorization required, and service not covered

Pre-Authorization Patient Handout

which services commonly need prior authorization — advanced imaging such as MRI, CT and PET scans, specialty medications, mental health care, durable medical equipment such as CPAP machines and wheelchairs, and ongoing physical or occupational therapy — with typical turnaround of 3 to 15 business days, or 24 to 72 hours when expedited

Medical Records Release Form

a HIPAA authorization form in four sections: patient information, who currently holds the records, who should receive them, and which records and date range are covered

These templates are general educational resources, not legal or billing advice. Check the wording against your own payer contracts and the requirements that apply in your state before using them.