How To Write A Medical Bill Dispute Letter . How to write a medical bill dispute letter to the credit bureaus use the medical bill dispute letter template above and replace the bracketed placeholders with your personal information. The hospital or other medical practice the debt originated from. Disputing A Medical Bill Sample Letter charlotte clergy coalition from charlotteclergycoalition.com I received treatment for a broken arm after an. [today’s date] [name of credit reporting agency credit reporting agency address Starting with your first phone call, write down the date and time, the name of every person you talk to and the information they share.