Sample letter of medical Necessity

[Guest guest]

Hi all,

I'm the newbie that posted in a panic two days ago. We've decided to

go with the DOCband for Kaity and are going on Monday for her casting.

I've looked everywhere and can't seem to find a sample letter of

medical necessity to show to my doctor so she can write one for me to

start the insurance appeals process. I know I saw one somewhere, but

I've been looking all morning and can't locate it.

Would one of you happen to have a link that could point me in the

right direction?

Thanks so much for all of your help!

Lesa, mother to Kaity (10-1/2 month old)

St. Louis, MO

[Guest guest]

Hi Lesa:

I am sure you're relieved to have at least reached a decision to

band. That is always such a hard decision to make. Good luck Mon,

please let us know how it goes.

I found the letter of med. necessity - it's in our " Files " section,

then " help folder " , then " insurance issues " ....but I copied & pasted

it for you below;

Hope it helps.

Debbie Abby's mom DOCGrad

MI

>>Letter of Medical Necessity

Re: Luck

To Whom It May Concern:

I am writing on behalf of the above named patient for whom we are

requesting orthotic correction of his cranial malformation of non-

synostotic origin. is a child with a skull deformity as a

result of a number of complicating factors. These have included that

is one of twin who suffered twin-to-twin syndrome, requiring

C-section because of tachycardia, prematurity at 29 weeks, postpartum

requiring intubation and NICU care for six weeks for management of

airway, hydronephrosis, anemia and hypertension. Because of early

birth and supine positioning throughout this care this has resulted

in deformational forces on a prematurely developed calvarial vault.

Moreover, this has been compounded by right side torticollis and

appropriate positioning to avoid sudden infant death as recommended

by the American Academy of Pediatricians. These factors have

resulted in an obvious cranial vault asymmetrical deformity

characterized as a parallelogram with right occipital flattening,

right frontal prominence and anterior positioning of the right ear.

Attempts to positionally correct this without more aggressive

intervention has been limited. Because of this, is a

candidate for non-surgical molding therapy. While there are some

centers that may correct this type of positional deformity with

surgery, the surgery is not without significant risks and associated

costs. The medical literature currently supports the use of a non-

operative, non-invasive correction of this condition through use of

dynamic orthodic cranioplasty. This involves correction of the

abnormal head shape with external forces. We feel that in 's

case the deformity is significant enough and that he is an

appropriate age for head molding to help improve the asymmetric

deformity. The results of dynamic orthodic cranioplasty typically

show good improvement and there are certainly many children who have

near complete improvement. The success correlates with the age at

the beginning of treatment and with the severity of the deformity.

It is important that the treatment be started early enough in

development to take advantage of the flexibility of the infant's

skull. Beyond a certain age, external molding will not be possible

and surgery is the only alternative if the deformity remains

significant.

It makes the most sense, from and economic and risk standpoint, to

correct these problems when they are easily corrected non-invasively

rather than to either leave them uncorrected and suffer natural

consequences or to offer a surgical solution that adds expense and

risk. It is on this basis that a treatment approach which involves

dynamic cranioplasty is medically indicated in cases like these.

We will continue to follow throughout the course of his

treatment. If further information is needed, please contact us

directly.

Sincerely,

Pravin K. Patel, M.D.

Attending Plastic and Reconstructive Surgeon

> Hi all,

>

> I'm the newbie that posted in a panic two days ago. We've decided

to

> go with the DOCband for Kaity and are going on Monday for her

casting.

>

> I've looked everywhere and can't seem to find a sample letter of

> medical necessity to show to my doctor so she can write one for me

to

> start the insurance appeals process. I know I saw one somewhere,

but

> I've been looking all morning and can't locate it.

>

> Would one of you happen to have a link that could point me in the

> right direction?

>

> Thanks so much for all of your help!

>

> Lesa, mother to Kaity (10-1/2 month old)

> St. Louis, MO