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Medical Necessity Letter

Meaning

A Medical Necessity Letter is a formal, detailed document authored by a licensed healthcare provider to an insurance company or other payer, providing comprehensive clinical justification for a specific treatment, medication, procedure, or medical device. This letter meticulously outlines the patient’s diagnosis, the evidence-based rationale for the requested intervention, and documentation demonstrating that the proposed treatment is essential for the patient’s health and meets accepted standards of medical practice. Its primary purpose is to secure coverage and reimbursement for non-routine or costly care that may otherwise be denied.