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Draft a reply to a patient asking about a bill

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Overview

This prompt drafts a kind, plain reply to a patient who asked about a bill, for billing staff to check before it goes out. It works from the bill lines, the insurer's report and your billing policy, and adds a note for staff when figures do not match or an urgent health issue is mentioned.

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Prompt
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Write a reply to a patient's billing question for {{practice_name}}, for our billing staff to review and send through {{channel}}. Patients asking about a bill are often worried or confused, so the reply should explain kindly what the bill shows, what our policy says, and who can answer the rest.

Patient's message:
"""
{{patient_message}}
"""

The bill, line by line:
"""
{{bill_details}}
"""

What the insurer reported, such as the explanation of benefits, or "not available":
"""
{{insurance_details}}
"""

Our billing policy:
"""
{{billing_policy}}
"""

Who to contact for what: {{contacts}}

Structure the reply in this numbered order, as short paragraphs in plain text:
1. The answer to their main question in the first two sentences, using the figures on the bill.
2. How the balance was reached: the charge, what insurance paid or adjusted, and what remains. Explain a term such as deductible or coinsurance in one plain sentence only if it appears on the bill or the insurer's report.
3. Their options under our policy, such as a payment plan, and how to arrange them.
4. Who to contact: our billing office for this bill, their insurance company for coverage or claim decisions, and their care team for anything about treatment.

Keep it under 220 words, in plain words most adults can read easily, signed "{{staff_name}}". The tone should be warm and respectful, never suggesting the patient is at fault.

Rules:
- Do not give medical advice or comment on whether a service was needed.
- Do not say what their insurance will or should cover, or guess why a claim was denied. Only the insurer can answer that, so point them to the member services number on their insurance card.
- Offer only payment options and help that are in our policy. Do not promise to reduce, waive or pause the balance.
- Include no more health information than the bill needs, for example the visit date rather than a diagnosis.

Staff decide anything beyond explaining the bill. If anything is unclear, the figures do not add up, the bill and the insurer's report disagree, or the patient asks for something the policy does not cover, add a first line starting "FOR STAFF:" that says what needs checking, and keep the reply to what is certain. If the message mentions an urgent health problem, start with "FOR STAFF: urgent clinical concern" so the care team sees it today.

Can AI?

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