Question: My physician sends a certified letter to patients right before turning their account over to collections. Can we charge the patient for this? These letters cost about $4.00. New York Subscriber Answer: No. Sending a letter to patients to inform them of their account status is the practice's responsibility as well as its professional obligation. The purpose of the certified letter is to have a record that the patient was notified and to retain a copy in his or her medical record. It also proves that the patient was informed because you now have a signature on file.