Helping not-for-profit hospitals find balance

Dispute a Bill

To dispute a bill, please complete the following form.

Fields marked in red are required.

Please enter your ASI account number (if known):
Please enter your full name
(Required)
First Name:
Last Name:
MI:
(Required)
Is the bill you are disputing for yourself?
If "No," are you a...
If disputing on behalf of a business, enter business name below:
Enter disputing party´s address:
(Required)
Address Line 1:
Address Line 2:
City: State: Zip:
Enter additional address (if any):
Address Line 1:
Address Line 2:
City: State: Zip:
(Required)
Phone Number:
Type of phone:
May we contact you at this number?
(Required) Enter your email address:
How may we contact you?:
(Required) Please describe in detail your reasons for disputing this bill:
By clicking "Submit," I acknowledge that Asset Systems, Inc. is a collection agency and any information obtained will be used for the purpose of collecting a debt.

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Monday - Friday


Portland

P: 503.233.0462
TF: 800.553.2406


Federal Way

P: 253.838.2971
TF: 800.553.2406