Billing Dispute Resolution Request
Ideally, disputes are filed with our office within 60 days of your date of service. No refunds will be provided for established standard office fees outlined in our Patient or Payment policies that are more than 90 days from the original date of service that the fee applies to.
Please provide as much information as you can about your Billing Dispute Resolution Request. Filing a Request does not guarantee that adjustments will be made to your account. If it is more appropriate to establish a payment plan, please contact our Billing Department at 515-243-2057 or our Office Manager Sabbath Schrader at sschrader@sfhcdsm.com
Patient Information
Please be aware that we will only speak directly to the patient, their legal guardian, or their spouse if they have been granted access to the account of the patient in question.
Charges or Fees in Question
Select all that apply.
Please provide multiple date information in the description box below.
Please provide specific details regarding the fees you are disputing. Please also provide any explanation on why you are seeking an adjustment or resolution to these fees. Please be aware that accurately billed medical services are unlikely to be adjusted, however a payment plan can be started with our Billing Department by calling 515-243-2057. Accounts with a payment plan in place will not be sent to Collections provided they remain current with their payments, or in communication with our Billing Department.
