Tips for Writing Letters of Medical Necessity

Letters of medical necessity are critical to getting reimbursed for any equipment or service. These are letters from your doctor or therapist. Such a letter must include certain, specific information or it will automatically be denied.

Many doctors and therapists are familiar with what needs to be in a letter of medical necessity. But if they don’t send the right information, it just means a longer delay and headache for you. Don’t take that chance.

You can help by writing down the answers to as many of the questions below as you can and giving it to your doctor or therapist. This will save them time and hopefully speed the process along.

1. Patient name, diagnosis, and the date the doctor prescribed the service or equipment needed.

2.  Patient’s diagnosis and how it relates to the service or equipment needed.

3.  Why the patient needs the service or equipment.

4. Patient’s overall therapeutic goals and how the service or equipment will help him meet those goals.

5.  A description of the product or service in as much detail as possible. This can come from the therapist or from the company that supplies a product. (You may be able to get this online).

6. The doctor or therapist’s phone number and email address, in case the insurance company has any questions.

Make a note of the date the letter was mailed. If you haven’t heard anything after 2-3 weeks, call the insurance company or funding agency and ask about the status of the claim. Make sure you write down the name of the person you talk to and get their permission to call them with any follow-up questions. Ask when a decision might be expected on payment.

If that date comes and goes, call again. Let them know you are tracking the request with dates and people’s names. But stay as pleasant as possible. You want their cooperation. If the agency or insurance company is unresponsive, get the doctor or therapist to help.

This good example of a letter of medical necessity is from Dr. Freeman Miller’s book Cerebral Palsy: A Complete Guide to Caregiving.

You can find more information about cerebral palsy and resources for parents and children with cerebral palsy at www.cpfamilynetwork.org.

How I Got Medicaid to Pay for Disposable Diapers

By Xiomara Montes

My daughter, Xaymara, is four years old. She has spastic quadriplegic cerebral palsy, as well as  epilepsy, seizure disorder and cortical blindness. We are a military family. When Xaymara was born premature at 29 weeks and we could see her development delays, we decided to move from Puerto Rico to the United States to provide her a better quality of life. We gave up everything we had in Puerto Rico to make the move, but her health and medical care were the most important things to us.

Xaymara receives Supplemental Security Income (SSI) and is also covered by Medicaid. As a military family, we also have military insurance. This insurance has paid for all the doctors, specialists and medical equipment that my daughter has needed. The one item we had trouble getting our military insurance to cover was disposable diapers. Here’s how we solved that problem:

First, we submitted the expense to the insurance company and received a denial. Then we called the company that supplies the diapers and told them we had been denied, but that we were covered by Medicaid. The company asked us to send them a “letter of necessity” from our doctor. We called the doctor and asked him to fax the information to the company. We also sent the company our Medicaid information. When the company received approval from Medicaid, they began sending us a monthly supply of diapers.

The lesson from this story is that even if you are denied by one agency, keep trying. Also, enlist the help of the company that sells the product or service you need.

Letters of necessity are super important when trying to get payment for equipment or supplies. For more information read Tips for Writing Letters of Medical Necessity.

CP Family Network offers more information on Medicaid and other government funding programs for children with cerebral palsy. Other helpful websites include:

http://www.medicaid.gov

New Law Provides Better Access to Medical Records and Buildings

On the 22nd anniversary of the Americans with Disabilities Act, two more milestones for disabled Americans have been reached:

• Guaranteed easy physical access to medical buildings, especially for adults and children in wheelchairs.
• Audio access for deaf and hard of hearing to medical information in a manner that is understandable to them.

These improvements are the result of settlements in complaints filed in Michigan and New Hampshire by the U.S. Attorney’s Offices. Known as the 200th Project Civic Access agreement, they led to the U.S. Justice Department Barrier-Free Health Care Initiative. The changes will impact more than four and a half million individuals with disabilities.
This nationwide initiative reinforces the message that disability discrimination in health care is illegal and unacceptable. Federal prosecutors across the nation will spearhead this new effort designed to guarantee access for disabled people to all medical buildings and to ensure the disabled are not discriminated against in receiving potentially lifesaving medical information.
Over the next few months, specific initiatives will begin. Be sure to follow CP Family Network on Facebook and Twitter for the latest news on cerebral palsy and disability rights.