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Letter of Medical Necessity Template
What Is a Letter of Medical Necessity?
A Letter of Medical Necessity is a written statement prepared by the physician to describe the current diagnosis of the patient and recommend treatment and medication. This document may be required for reimbursement if the treatment entails expenses that must be covered by the insurance provider or for the medical facility that needs a professional opinion of the doctor that knows the patient well and can provide them with basic details about the patient's medical history and prognosis. You can download a Letter of Medical Necessity sample below.
How to Write a Letter of Medical Necessity?
You may customize a Letter of Medical Necessity template the way you deem correct - there is no uniform format, and as long as this document contains all important details about the patient's health condition and you offer the recipient a chance to contact you and know more, this statement will be accepted and reviewed.
Follow these steps to compose a Medical Necessity Letter:
- Greet the recipient - if you know the individual who will review your documentation, you should address them by their name; otherwise, it would fine to simply write "To whom it may concern".
- Introduce yourself and state your name and position . Indicate the purpose for writing the letter - you are preparing this statement on behalf of your patient.
- Record the date you last assessed the individual in question . Add the name of the patient and specify the treatment they require, the medication they must be prescribed, or the equipment they must be provided with. Explain your diagnosis and shortly summarize your professional opinion about the possibility of recovery. If you need to attach documentation that outlines the patient's medical history and diagnosis more extensively, you may refer to the enclosed files, but keep the references comprehensible to make it all clear to the letter reader. Make sure you describe why the treatment and/or medication are medically necessary in accordance with the requirements and rules established by the party that requested the letter - for instance, the insurance company may ask you to calculate the cost of treatment and explain the patient' life is in danger or they may develop a handicap.
- State the duration of the required treatment, medication timing and dosage, and other necessary details you recommend adhering to . Note that the period you indicate should not exceed one year - after that time, it is a good idea to prepare another Medical Letter of Necessity to update information.
- Add your contact information and offer the recipient of the letter to call or write to you if they have any questions or concerns.
- Sign and date the letter and give it to the patient or send it directly to the medical provider or insurance company that requested it . Make another copy of the letter and keep it in the patient's records - you may need to expand on it in the future or present it as evidence if the recipient refuses to provide the patient with treatment or equipment.
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