This letter is being sent to you in response to your recent letter dated XX/XX/XXXX ; which wasnt received at my home until XX/XX/XXXX. This is not a refusal to pay, but a notice that your claim is disputed. Please note this is my second letter to you and I have now sent this certified mail and I will know when you receive it. 

In my first letter, I stated that I applied for financial Aid through the provider. The same day that was denied, my account was sent to collections without giving me the opportunity to set up a payment plan. I sent you this letter per certified mail so I know that you received it at your office. You did not respond. 

Under the Fair Debt Collections Practices Act ( FDCPA ), I have the right to request validation of the debt you say I owe you. I am requesting proof that I am indeed the party you are asking to pay this debt, the date of the alleged medical service, the name of the patient, and proof that there is some contractual obligation which is binding on me to pay this debt. 

Please attach copies of : Any agreement with your client that grants you the authority to collect on this alleged debt, or proof of acquisition by purchase or assignment, and authorization under subtitle D of the ARRA, SEC. 13401. APPLICATION OF SECURITY PROVISIONS AND PENALTIES TO BUSINESS ASSOCIATES OF COVERED ENTITIES ; and SEC. 13407 ( 1 ) BREACH OF SECURITY.

The term breach of security means, with respect to unsecured PHR identifiable health information of an individual in a personal health record, acquisition of such information without the authorization of the individual. 

Please note that enforcement of penalties against you is covered under the penalty rules of the Omnibus Final Rule effective XX/XX/XXXX interpreting and implementing various provisions of the Health Information Technology for Economic and Clinical Health Act of XX/XX/XXXX ( HITECH Act ) as issued XX/XX/XXXX and the penalty rules of the FCRA and FACTA including FACT Act changes final rules effective XX/XX/XXXX. 


Please also attach copies of any agreement that bears the signature of the alleged debtor wherein he or she agreed to pay the creditor and as this is a medical account a copy of any HIPAA authorization. 

Please also be advised that this letter is not only a formal dispute, but a request that you cease and desist any and all collection activities, including reporting of ; or verifying of this account on my credit reports. 

I require compliance with the terms and conditions of this letter within 30 days or a complete withdrawal, in writing, of any claim. 

In the event of noncompliance, I reserve the right to file charges and/ or complaints with the OCR on your HIPAA violations and appropriate County, State & Federal authorities, the CFPB , BBB and State Bar associations for violations of the FDCPA, FCRA, and Federal and State statutes on illegal  collection activities on any account that may be time-barred as well as in violation of Kentucky medical privacy rules. 
I also hereby reserve my right to take private civil action against you to recover damages. 


XXXX XXXX Hospital I am allowed under the Health Insurance Portability and Accountability Act ( HIPAA ) to protect my privacy and medical records from third parties. I did not give permission to any of my current or prior medical providers to release any of my medical information to a third party. I am aware that the HIPAA does allows the release of limited information about me but anything more is to only be revealed with the patients authorization. Therefore, by obtaining and sending me an itemized copy of my medical notes you have violated my HIPPA Rights.