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Hipaa Letter 2 - Coll Agency - WORD

This document is a letter addressed to a collection agency regarding medical bills, asserting the sender's rights under HIPAA to protect their medical information. The sender requests validation of the debt, including a breakdown of fees and proof of authorization for the release of their medical information. Additionally, the letter demands that the collection agency cease credit reporting until the debt is validated and warns against potential violations of the FDCPA and Fair Credit Reporting Act.

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154 views2 pages

Hipaa Letter 2 - Coll Agency - WORD

This document is a letter addressed to a collection agency regarding medical bills, asserting the sender's rights under HIPAA to protect their medical information. The sender requests validation of the debt, including a breakdown of fees and proof of authorization for the release of their medical information. Additionally, the letter demands that the collection agency cease credit reporting until the debt is validated and warns against potential violations of the FDCPA and Fair Credit Reporting Act.

Uploaded by

gabby maca
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HIPAA Letter for Medical Bills 2

Send To: Collection Agency


Purpose: Send this to the collection agency who is collecting on behalf of your medical bills.
Your Name
Your Address
City, State, Zip Code

Collection Agency Name


Collection Agency Address
City, State Zip Code

Re: Account Number

I am allowed under the HIPAA law (Health Insurance Portability and Accountability Act of 1996) 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 understand that the HIPAA does allow for limited
information about me but any details may only be revealed with the patient’s authorization, therefore my
request is twofold and as follows:

Validation of Debt and HIPAA authorization

- Please provide a breakdown of fees including any and all collection costs and medical charges
- Please provide a copy of my signature with the provider of service to release my medical information to you
- Immediately cease any credit bureau reporting until 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.

Please note that withholding the information you received from any medical provider in an attempt to be
HIPAA compliant will be a violation of the FDCPA because you will be deceiving me after my written request.
I am requesting full documentation of what you received from the provider of service in connection with this
alleged debt.

Furthermore, 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 await your reply with the above requested proof. Upon receiving it, I will correspond back with you by mail.

Best Regards,

Your Name

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