Duplicate charge appeal

{{your_name}} {{your_address}} {{provider_name}} Billing Department {{provider_address}} Re: Duplicate charge on account {{your_account}}, date of service {{visit_date}}, claim {{claim_or_invoice}} To whom it may concern, I'm writing to formally dispute a duplicate charge on the above account. CPT/HCPCS code {{duplicate_code}} appears twice on this bill for the same date of service, billed at {{duplicate_amount}} per line, for a total of double the correct amount. I received this service only once. Charging twice for one service is overbilling, prohibited under the False Claims Act (31 U.S.C. § 3729) where federally-funded payors are involved, and a contract violation between provider and payor in all cases. I'm requesting: 1. Immediate reversal of one of the duplicate {{duplicate_code}} line items. 2. A corrected itemized statement showing the single, accurate charge. 3. Written confirmation that my account balance has been adjusted accordingly. Please respond in writing within 30 days. If I do not receive a response, I will escalate this to my insurance carrier and, if applicable, my state's Department of Insurance. Thank you for your prompt attention. Sincerely, {{your_name}}