Bill exceeds the EOB

{{your_name}} {{your_address}} {{provider_name}} Billing Department {{provider_address}} Re: Bill exceeds EOB patient-responsibility - account {{your_account}}, date of service {{visit_date}} To whom it may concern, I'm disputing the amount of {{billed_amount}} billed on the above account. The Explanation of Benefits issued by {{insurer_name}} for this claim lists my patient responsibility as {{eob_responsibility}}. The bill you sent me is for {{billed_amount}}, which exceeds the EOB amount. The EOB is the authoritative document for what I owe after insurance adjudication. Any amount above that figure must be corrected. I'm requesting: 1. A corrected bill matching the EOB patient responsibility of {{eob_responsibility}}. 2. An explanation in writing if you believe the excess is due to a charge the EOB did not cover (e.g. a non-covered service line) — please identify the specific service and rule. Please correct this within 30 days, before any reporting to credit bureaus would otherwise begin under the Fair Debt Collection Practices Act timeline. Sincerely, {{your_name}}