Letter Of Medical Necessity For Exercise Equipment. Example letter #1 of medical necessity the following example letter of medical necessity and advice are only intended to assist you in writing your own letter to aid in securing funding for medical equipment. If a time period is not stated, the letter of medical necessity will be valid for one year.
It is the formal medical judgement of a licensed physician as to why a patient needs a specific treatment and why other treatments are not appropriate. Please note, treatments that are considered to be solely for general well being, or are personal care items, are not reimbursable under code 213(d). December 17, 2009 any insurance company 123 any street any city, any state 12345 re:
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A treadmill is not eligible for reimbursement with a limited care flexible spending account (lcfsa) or a dependent care flexible spending account (dcfsa). Letter of medical necessity under internal revenue service (irs) rules, some health care services and products are only eligible for reimbursement from your health care fsa, limited purpose fsa, and hra when your doctor or other licensed health care provider certifies that they are medically necessary. Letter of medical necessity for bariatric surgery sample. A letter of medical necessity is a written statement prepared by the physician to describe the current diagnosis of the patient and recommend treatment and medication.this document may be required for reimbursement if the treatment entails expenses that must be covered by the insurance provider or for the medical facility that needs a professional opinion of the doctor that knows the patient.