Virginia Sample Letter for Enclosure of Medical Reports
Description
How to fill out Sample Letter For Enclosure Of Medical Reports?
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FAQ
[Patient's name] requires treatment for a medical condition. I respectfully request that you review the additional documentation provided and consider overturning your coverage decision regarding [insert specific language from the denial letter] for [patient's name]. Thank you for your prompt attention to this matter.
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. On behalf of the patient, I am requesting approval for use and subsequent payment for the [TREATMENT].
How is ?medical necessity? determined? A doctor's attestation that a service is medically necessary is an important consideration. Your doctor or other provider may be asked to provide a ?Letter of Medical Necessity? to your health plan as part of a ?certification? or ?utilization review? process.
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.
A patient can write the letter, but it needs to be made official by a doctor. Any arguments for any service ultimately have to come from a treating physician. That means the doctor needs to know you, have some history with you, and in the end either write or 'sign off on' the letter.
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].