This content is slightly modified from Carreon and Associates. See Chapter Three for information about medical debt.

Request to Validate Medical Debt

[Your name]

[Your address]

[Address of collection agency]

[Date]

Amount of debt: [ ]

Date of Service: [ ]

Provider of Service: [ ]

Dear collection agent,

I received a bill from you on [date] and as allowed under the Fair Debt Collection Practices Act (FDCPA), I am requesting that you allow me to validate the alleged debt. I am aware that there is a debt from [name of hospital/doctor], but I am unaware of the amount due and your bill does not include a breakdown of any fees.

Additionally, I am allowed under the Health Insurance Portability and Accountability Act (HIPAA) to protect my privacy and medical records from third parties. I do not recall giving permission to [name of provider] for them to release my medical information to a third party. I am aware that the HIPAA does allow for limited information about me but anything more is to only be revealed with the patient’s authorization. Therefore my request is twofold—validation of debt and HIPAA authorization.

• Please provide breakdown of fees including any collection costs and medical charges.
• Provide a copy of my signature with the provider of service to release my medical information to you.
• Cease any credit bureau reporting until the debt has been validated by me.

Please send this information to my address listed above and accept this letter, sent certified mail, as my formal debt validation request, which I am allowed under the FDCPA. Please note that withholding the information you received from any medical provider in an attempt to be HIPAA compliant can be a violation of the FDCPA because you will be deceiving me after my written request. I request full documentation of what you received from the provider of service in connection with this alleged debt.

Additionally, any reporting of this debt to the credit bureaus prior to allowing me to validate it may be a violation of the Fair Credit Reporting Act, which can allow me to seek damages from a collection agent. I will await your reply with above requested proof. Upon receiving it, I will correspond back by certified mail.

Sincerely,

[Your Signature]

[Your Printed Name]

Certified mail No: [ ]