A Letter of Medical Necessity may be required when filing an insurance claim. It is completed by the physician or prescriber and helps to provide the medical justification for potential insurance benefits. Patients or caregivers may download the relevant sample Letter of Medical Necessity and provide to their physician or prescriber to complete and sign. Sections of each letter have been left unprotected so that the physician or prescriber may include patient specific information.

Click here for Letters of Medical Necessity

formula4success™ and its agents and contractors do not guarantee coverage by any insurance plan providers and will not reimburse any claims denied by third party payers.


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