A letter of medical necessity is a document that is usually issue by a medical professional on behalf of a patient seeking reimbursement for a medical procedure. There are very common for medical procedures that are not covered under standard health care plans, so it is necessary for a special request to be made. The recipients of these letters are usually health insurance companies or health care provision companies.

Sample letter of medical necessity

Star Insurance

Nelson V. Ziebarth

2784 Ryan Road
Bryant, SD 57221

To Whom It May Concern:

Janine Baker has recently been diagnosed with a rare form of lung disease, which causes great difficulty breathing and respiratory problems for the patient. The symptoms have gotten progressively worse, to the point where they are beginning to affect the lifestyle that Janine can live.

Janine has taken part in many different medical procedures, but they have not been successful in remedying the problem. There is a new technology that can be used to combat this disease, but it is currently not covered under Janine’s healthcare program.

Please consider coverage for this new disease prevention technology for Janine. If you would like additional information and potential costs for this procedure, don’t hesitate to contact me at 342-234-2343

Sincerely,

Dr. Kreuger