Medical Necessity Appeal Letter-Financial Aid Appeal Letter Sample

Medical Necessity Appeal Letter-Financial Aid Appeal Letter Sample

It is always better to embrace yourself with all the necessities to face any unexpected situation. Medical necessity is one such important thing. It is basically a written statement in the form of prescription by the doctor stating the patient's conditions along with the necessary diagnostic procedures that are needed to find out a possible treatable condition, or to enhance and restore the functional ability and quality of life to the patients.

Sometimes, even though you hold a medical insurance, the insurer provider denies settling the claim submitted by you. Your medical policy booklet states the conditions under which the insurer can deny your claim. Before appealing against the denial, go through the policy booklet and get informed about their denial rights.

When your doctor submits a medical necessity report, it should clearly make a distinction between comfort and necessary. The insurer will not accept your claim if it is meant for comfort, experimental, investigational, or cosmetic purposes. They need prior information about the medical necessity, especially in case of extensive medical treatment. If the patient requires some aid for their mobility, then they need to know why that particular equipment or medication is necessary.

Medical Necessity Appeal Letter Sample

Your Name

Address

City, State, Zip Code

Date

Recipient Name

Title

Insurance Agency/Company

Address

City, State, Zip Code

Subject: Appeal against denial of medical necessity

Dear Sir/Madam,

My name is (your name) and I am a medical policy holder of your company since (insert date). I am writing this medical appeal letter against the denial of the claim settlement.

Recently, I met an accident and had to be hospitalized for three weeks. I suffered a serious fracture on my right leg with kneecap dislocation. The doctor had performed surgery and placed a rod inside my leg. As I couldn't move on my own, the hospital provided me a standard walker for ambulation.

The standard walker is necessary for me as it would help me with some movements in joints. I will have to rely on it for at least six months as I am strictly warned not to exert pressure on my right leg.

At the time of discharge and settling the hospital bill, I was surprised to know that there is no coverage provided for the medical equipment under my policy. I had to pay $700 from my pocket for the standard walker. I hope you can understand how necessary the standard walker is for me.

I am enclosing the doctor's medical necessity statement along with this appeal letter for your reference. Please call me for any queries and do the needful at your earliest.

Yours truly,

(Your Name)

Your medical insurer sometimes denies your claim in absence of medical necessity. If that is the case, please ask the hospital to send it to the insurer, or get a copy of it and send it along with this appeal letter.

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Source - http://www.howwriteletter.com/appeal-letter/medical-necessity-appeal-letter.html

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