Appeal Letter Sample For Medical Necessity



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How to write an Appeal Letter Sample For Medical Necessity? Download this Appeal Letter Sample For Medical Necessity template that will perfectly suit your needs.

Our collection of online health templates aims to make life easier for you. Our site is updated every day with new health and healthcare templates. By providing you this health Appeal Letter Sample For Medical Necessity template, we hope you can save precious time, cost and effort and it will help you to reach the next level of success in your life, studies or work!

To whom it may concern,
I am writing this letter on behalf of my patient, {{{{PATIENT NAME}}}}, to appeal the denial of coverage for genetic testing offered through the Center for Precision Diagnostics, a CLIA certified laboratory located at the {{University Name}} in {{Location}}. This letter documents the medical necessity for this test to identify the genetic cause of {{NAME OF DISORDER}} condition and provides information about
{{PATIENT NAME}} medical and family history, and treatment to date.
{{PATIENT NAME}} is an {{AGE}} year old {{SE}}X with a diagnosis of {{NAME OF DISORDER}} (ICD-9 XXXXXX)
{{DESCRIBE DISORDER}}
{{PATIENT NAME}} has been evaluated by numerous specialists at {{INSTITUTION}} {{PATIENT NAME}} has had extensive medical testing including, but not limited to, {{DESCRIBE PERTINENT TESTING TO}}
{{DATE}}. None of these physicians or tests has provided {{PATIENT NAME}} with a diagnosis.
The fact that {{HE/SHE}} has {{PARTICULAR FEATURES OF THE DISORDER (E.G …)} is strongly indicative of a genetic etiology, since they did not occur following medication or infection or other exogenous cause. This personal and family history, as well as {{PATIENT NAME}}’s examination, are not consistent with any known {{DISEASE CATEGORY}} conditions, but are indicative of an underlying genetic cause.
The most efficient and cost-effective way to confirm a genetic diagnosis in this patient is to perform {{LIST}}{{GENES}} genetic testing. Results from this genetic test will have a direct impact on this patient’s treatment and management and will provide prognostic information that will assist in clinical management.
As mentioned above, knowledge of this patient's genetic information is important for me to more accurately assess her prognosis and will guide my recommendations for care.
To summarize, I am requesting to appeal {{XXX}}s denial for genetic testing through the {{Diagnostic Laboratory}} with the following CPT code(s):{{CPT CODES}}. Thank you for your review and consideration. I hope you will support this letter of medical necessity for {{XXX}}. 
If you have any queries in the meantime please contact me directly. I will be available on phone: {{T+00000000}} and email: {{email}} in case of any query.
{{Additional questions}}
Yours sincerely,
{{Doctor Position}}


This Appeal Letter Sample For Medical Necessity is intuitive, ready-to-use, and structured in a smart way. Try it now and let this Appeal Letter Sample For Medical Necessity sample inspire you.

We certainly encourage you to download this Appeal Letter Sample For Medical Necessity, especially if the insurance company denied the patient coverage of genetic testing. 


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