You must file a notice of appeal with the Minnesota Department of Human Services. (DHS) within 30 days of the date you received the denial.The document provides two sample request letters asking for financial assistance to pay hospital bills. To write a letter requesting help with hospital bills, start with a polite greeting and introduce yourself, mentioning your situation briefly. Copy and paste our template letter and fill in your details. Request an itemized statement from the clinic or hospital. An itemized statement should contain a full accounting of the services provided to you. If your insurance has paid part of the bill but you need help in paying your balance, you can apply for Financial Assistance. If you receive assistance from or live in a home with a family or friends, please have them complete the attached form labeled "Letter of Support. Medicare may pay you directly when you complete this form and attach an itemized bill from your doctor or supplier.