[Your letterhead, if desired; if not, your return address]

[Date of letter-month, day, and year]

[Recipient's first and last names]
[Company name]
[Street or P.O. box address]
[City, State ZIP code]

Dear [recipient's name]:

We are writing to notify you that we have received and reviewed your request for a debt cancellation of your medical bill with our office. After careful consideration, we have decided to cancel $300 out of the $500 that you owe our office. Thus, your balance is now $200.

Please call our billing office to make this $200 payment or to make arrangements to pay this balance as soon as possible. We will be happy to work out a payment plan with you if you are unable to pay the $200 amount in full at this time. Thank you for submitting your request for a debt cancellation and for your prompt attention to the $200 balance due.

Sincerely,

 

[Signature]

[Sender's first and last names]