Your Part in Obtaining a Letter of Medical Necessity
When your child needs a particular medication, therapy, treatment, or assistive device, your request to an insurance company, government agency or other funding source can sometimes be denied. Oftentimes they will require a letter of medical necessity, which is typically provided by your physician or therapist. Letters of medical necessity are critical to getting coverage for the equipment or service your child needs and must include certain, specific information or your request will automatically be denied…again.
Many doctors and therapists are familiar with what needs to be in a letter of medical necessity. But if they don’t provide the right information, it just means a longer delay and more headache for you. Your best bet is to get all pertinent information in front of your provider so the letter will be right the first time.
You can help by making sure your doctor or therapist has included:
- Their credentials and relationship to the requesting party.
- The details of the original prescription.
- Patient name, diagnosis, and the date the service or equipment was prescribed.
- Patient’s diagnosis and how it relates to the service or equipment needed.
- Why the patient needs the service or equipment.
- Patient’s overall therapeutic goals and how the service or equipment will help meet those goals.
- 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 (this information can often be found online).
- The doctor or therapist’s phone number and email address, in case there are any questions.
Be Polite, But Persistent
Being your child’s best advocate means keeping on top of providers so your request doesn’t slip through the cracks. 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 with and when you spoke. 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.
The road to getting complete, proper care for your child can be rough, but you don’t have to travel alone. If you believe your child has suffered medical malpractice that caused their cerebral palsy, you may be able to pursue a claim for compensation to help you meet the costs of medical treatment, therapy, adaptations to your home, and other expenses. The Cerebral Palsy Family Lawyers at Janet, Janet & Suggs have over 40 years of experience helping families get justice for their loved ones. Contact us today so you can benefit from our legal and medical expertise.