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Patient billing survey template

Make medical bills make sense, before patients call to ask

Four questions for a week after the bill goes out: whether the amount was what patients expected, how easy the bill was to understand and to pay, and what was unclear. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this patient billing survey tells you

A patient billing survey asks patients about the bill itself: whether the amount matched what they expected, whether they could understand it and how easy it was to pay. This template asks four questions in under a minute and ends with what was unclear, in the patient's own words.

It is written for a week after the bill goes out, sent by Usertick email to the patients billed that week, when most have opened it and some have tried to pay. The same survey runs as a link on your online billing page, as a QR code printed on the paper statement, or inside the page at the end of a help page about reading the bill.

Results shows the share who found the amount expected, the average for understanding the bill with the share of 4s and 5s, and the payment ease score with the share who found it easy. Every written answer is read as it arrives and filed under a category such as billing and insurance, with a type and an urgency, so a billing error stands out in the inbox.

In an emailAs a linkOn your websiteAs a conversation
Questions
4
Time to answer
About a minute
Written for
A week after the bill goes out, by email or a QR code on the statement
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 4 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 4 · Yes / No

Was the amount what you expected?

Why ask it
A surprise amount turns a routine bill into a phone call. Asking first, with a yes or no, separates a bill that was hard to read from a bill that was higher than the patient was told.
What you learn
The share that said yes, against the period before. Select No to narrow the page to those patients and read what was unclear to them.
Make it yours
Keep it first: a yes or no question sits inside the email, so patients answer with one tap.
Question 2 of 4 · Stars

How easy was your bill to understand?

Why ask it
Codes, adjustments and insurance lines can make a correct bill hard to follow. A 5-point rating from very difficult to very easy measures how readable the statement is.
What you learn
The average, a bar per rating and the share who rated 4 or 5, compared with the period before, so a redesigned statement shows up in the next period.
Make it yours
When you change the layout of the statement, note the date and compare the period after with the period before.
Question 3 of 4 · Customer effort

How easy was it to pay?

Why ask it
Patients who find it hard to pay end up paying late or calling. A 1 to 7 effort scale measures the payment step on its own, whether it happens online, by phone or by mail.
What you learn
The average on the 1 to 7 scale and the share who found it easy, with a hard-to-easy bar, against the period before.
Make it yours
When you offer several ways to pay, add a question that asks which one the patient used, then select each answer to compare their ease scores.
Question 4 of 4 · Text · Optional

What was unclear?

Why ask it
The answer to what was unclear tells the billing team which line, term or step to rewrite.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a question, a complaint or an idea and flags the urgent ones.
Make it yours
Use the placeholder to ask about the wording and the amounts, and to leave out account numbers and treatment details.

What the answers show

Results turns each question into numbers you can follow week by week.

How easy was your bill to understand?

The average rating and the share who gave 4 or 5 stars, against the period before.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Medical bill clarity in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Send it a week after billing

    Schedule the send for a week after each billing run, so most patients have opened the bill. Usertick schedules sends up to 30 days ahead.

  2. 02

    Reply to billing questions

    Some written answers will be questions about a specific bill. Give each one an owner in the inbox, so someone from billing replies to the patient.

  3. 03

    Fix the biggest confusion first

    Filter the written answers by theme, rewrite the part of the statement behind the largest theme, and watch the understanding score in the next period.

  4. 04

    Keep account details out

    Ask patients to describe what was unclear without account numbers or treatment details. Usertick's terms don't allow health records or medical details in surveys, and Usertick doesn't sign business associate agreements.

Customer supportPatient satisfaction surveysEmail surveysBilling and insurance questions

More support templates and questions

Templates like this one, and single questions from the library to add to it.

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SupportSupport follow-upCheck whether a support conversation actually solved the problem, how much effort it took and how the person who helped did. Send it automatically when a ticket is closed.
SupportHelp article feedbackLearn whether your help articles answer people's questions and which topics are missing or outdated. Add it to the bottom of every help article.

Questions from the library

Browse the question library
  1. Did you understand your bill?Yes / No · Billing and insurance
  2. How clear was the bill?Stars · Billing and insurance
  3. Were you told the cost before treatment?Yes / No · Billing and insurance
  4. Who are you caring for?Dropdown · Caring for an older relative
  5. How many hours a week do you spend on their care?Ruler · Caring for an older relative
  6. Are you able to speak to their care team on their behalf?Yes / No · Caring for an older relative

Frequently asked questions

About a week after the bill goes out, when most patients have opened it and some have paid. Usertick sends email now or at a time you schedule up to 30 days ahead.

Four is enough. This template asks four and takes under a minute.

Yes. Print the survey's QR code on the statement, and it opens the hosted survey page in the patient's phone browser.

Select No on the first question and read what those patients found unclear. When the pattern is about estimates, give patients a written estimate before care; when it is about insurance, explain the patient's share on the statement.

Yes. On every plan, a workflow can add each response to a Google Sheet or call a webhook, and from Starter it can also create a Zendesk ticket for each billing question.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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