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.