Letter of Medical Necessity: A Guide for Families Transitioning from the NICU
After your child’s NICU stay, you'll be navigating a new routine at home, managing ongoing medical needs, and ensuring that your baby gets the best care possible. One essential tool that can help make this process easier is a letter of medical necessity.
You might be wondering: What is it? Why do I need one? And how do I ask for it? Don’t worry, we’ve got you covered. Here’s a simple guide to help you understand what this letter is, why it’s so important, and how to get it so you can focus on your baby’s well-being.
What Is a Letter of Medical Necessity?
A letter of medical necessity is basically a letter from your child’s doctor that explains why certain medical treatments, equipment, or therapies are needed for their health.
This letter is usually sent to insurance companies, schools, or other places that might need some solid proof that the treatment or service is essential for your child’s recovery or growth.
Think of it as a professional note from your child’s doctor that helps make sure your baby gets what they need, whether it’s special equipment, therapy, or medical support.
Why Do You Need a Letter of Medical Necessity?
When your baby leaves the NICU, you may find that they still need some extra care to continue their healing or growth at home. This could be things like:
Medical equipment (oxygen, feeding tubes, monitors, etc.)
In-home healthcare (nursing, respite)
Specialized therapies (speech therapy, occupational therapy, physical therapy)
Medications or treatments that need insurance coverage
Insurance companies and other providers often require proof that these things are medically necessary before they will approve coverage or financial help. That’s why the letter of necessity is important - not having one may result in a denial of services or procedures and may lead to delays in care.
Who Should You Request a Letter of Medical Necessity From?
You’ll want this letter to come from someone who knows your baby’s medical history inside and out. This could be:
Your baby’s pediatrician or primary care doctor
The neonatologist (specialist in newborn care) who cared for your baby in the NICU
Other specialists who have been involved in your baby’s care (e.g., pulmonologists, cardiologists, neurologists)
The key is that the doctor or specialist understands your baby’s ongoing needs and can clearly explain why certain equipment or services are needed. It’s totally okay to have a conversation with your doctor beforehand to make sure they’re on the same page.
How to Request a Letter of Medical Necessity
Requesting a letter of medical necessity can feel a little intimidating, but don’t worry —this is a common request. Healthcare providers are used to writing these letters and they understand it’s a necessary part of getting your child the right care.
Here’s a simple step-by-step guide:
Identify What’s Needed: Make a list of exactly what your baby needs, whether it’s a piece of medical equipment, therapy, or a treatment.
Check With Your Insurance: Sometimes insurance companies have their own forms or guidelines for these requests. It’s helpful to check in with them so you can provide your doctor with everything they need upfront.
Make the Request: Call your doctor’s office and ask for the letter. Let them know exactly what it’s for and why it’s so important. You might want to follow up with an email just to be sure everything’s clear.
Provide Any Extra Documentation: If your insurance or another organization asks for extra paperwork (like medical records), make sure both you and your doctor have what’s needed.
Follow Up: If you don’t get the letter within a week or two, don’t hesitate to call and check on the status of your request.
Sample Template for Requesting a Letter of Medical Necessity
Here is a template that you can use when requesting a letter of medical necessity from your child’s healthcare provider.
[Your Name and Contact Information]
Date: [Insert Date]
[Provider’s Name, Title, Facility Name + Contact Information]
Dear Dr. [Provider’s Last Name],
I am writing to request a letter of medical necessity for my child, [Child’s Full Name and Date of Birth], who has recently been discharged from the NICU. As we transition to life at home, we are working to ensure that all of [Child’s Name]’s medical needs are fully met.
Specifically, I am requesting a letter to support the need for [list specific equipment, therapy, or service needed, e.g., oxygen support, feeding tube, home nursing care, etc.]. This letter will be submitted to our insurance company to facilitate coverage and ensure that our child’s needs are met in the home setting.
Please let me know if you require any additional information or documentation to process this request. I greatly appreciate your support in helping us secure the necessary services and equipment for [Child’s Name].
Thank you so much for your attention to this matter. I look forward to hearing from you.
Sincerely,
[Your Name]
Sample Template of a Letter of Medical Necessity
To make the process even easier, consider sharing a pre-filled letter that includes the item, service, or procedure being requested. That way, your child’s provider can simply review it, make any needed edits, sign, and return it on their letterhead.
Date: [Insert Date]
[Provider’s Name, Title, Facility Name + Contact Information]
RE: Letter of Medical Necessity for [Child’s Full Name]
DOB: [Insert Date of Birth]
Insurance ID: [Insert if needed]
To Whom It May Concern,
I’m writing on behalf of my patient, [Child’s Full Name], a [age]-year-old child with a medical history that includes [diagnosis/es], which impact [brief summary — e.g., mobility, communication, feeding, etc.]. Due to these challenges, I’m recommending [name of service, therapy, or equipment] as medically necessary to support [his/her/their] ongoing care and development.
[Child’s First Name] has shown [progress or needs —e.g., steady gains with current therapy, increasing difficulty with daily tasks, etc.], and based on my clinical judgment, this [service/item] is an important part of meeting [his/her/their] current and long-term needs.
Thank you for your consideration. Please reach out if you need any additional information.
Sincerely,
[Provider’s Name]
[Title]
[Provider Credentials]
We know that transitioning from the NICU to home care is a big shift, and there’s a lot to figure out. But with the right tools in hand, like a letter of medical necessity, you can make sure your baby gets the equipment, therapies, and treatments they need.
And don’t forget: you’re not alone in this! Your healthcare providers are there to help, and this letter can make sure the insurance and services get lined up, giving you one less thing to worry about.
