Understanding a Letter of Medical Necessity
Tired of insurers who practice medicine from afar?
Here is your chance to help your patient obtain needed care.
A good letter of medical necessity from the prescribing doctor
- is crucial to many prior authorization requests,
- is essential in the grievance and appeals process for DPW and HMOs.
In a good letter of medical necessity
- the physician must be clear about the medical reasons why a patient needs medication or
equipment AND how the reasons fit the legal definition of medical necessity under Pennsylvania Medicaid.
A letter which encompasses both these aspects will be a strong letter. You must be able to support your medical judgment about what is best for your patient.
click here to reach a template for writing a letter of medical necessity under Pennsylvania HealthChoices. You will be able to insert relevant information into the letter and print out on your own stationery.
