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A letter of medical necessity is a document that you submit to your insurance company requesting coverage for a procedure or equipment. This letter describes why something is medically necessary for the treatment or rehabilitation of the beneficiary.
I am writing on behalf of my patient, [PATIENT NAME], to [REQUEST PRIOR AUTHORZATION/DOCUMENT MEDICAL NECESSITY] for treatment with [INSERT PRODUCT]. The [PATIENT NAME] has a diagnosis of [DIAGNOSIS] and needs treatment with [INSERT PRODUCT], and that [INSERT PRODUCT] is medically necessary for [him/her] as prescribed.
This includes a brief description of the patient's diagnosis, the severity of the patient's condition, prior treatments, the duration of each, responses to those treatments, the rationale for discontinuation, as well as other factors (eg underlying health issues, age) that have affected your treatment selection].
The LMN requesting HHC must include: The accepted condition(s). The current treatment the patient is undergoing or is recovering from, and the specific physical limitations based on objective medical evidence. A description of any effects that non-covered illnesses have on the need for services.
Justifying Medical Necessity Treatment is consistent with the symptoms or diagnosis of the illness, injury, or symptoms under review by the provider of care. Treatment is necessary and consistent with generally accepted professional medical standards (i.e., not experimental or investigational).