Insurance > Sample Letter
A Basic Outline for a Letter of Necessity
1. Introduction: Introduce the patient including pertinent information such as age, diagnosis, overall applicable symptoms, current care requirements, and how long she or he has had this condition. You will have to gauge how much information to share that will paint a good picture of the condition and needs of the individual.
2. Establish the Need: This may be anywhere from one to three paragraphs and if you have more information, consider adding attachments not just lengthening the letter. Building off the introduction, tie the detailed clinical description of the patient's condition / needs to the challenges and risks in and around beds. For example, "low muscle tone increases his risks of entrapment and resulting injury or death" .
3. In addition to the clinical description, you may want to elaborate on the physiological challenges that are created by their condition. Some examples include a history or propensity for: falling, climbing, seizure activity, lack of muscle tone and/or control, increased risks of entanglement with bolt on side rails or "hospital/institutional" bed rails, and entrapment or suffocation risks due to the gaps around the mattress found in most beds and some institutional beds -- especially for children.
4. We also believe in outlining the psychological benefits and risks that are addressed by the patient having (or not) safety and freedom as well as the ability to see out, to not be trapped or locked in, etc.
5. You will need to effectively communicate the dangers of either the current bed and/or dangers of standard bed choices, including inexpensive hospital beds. For example, many patients need to transition from a crib to a larger bed, and going to a normal bed won't be safe, or the patients condition is worsening and now needs additional assistance, etc. The dangers need to be broken down by how they fail to protect the patient due to their medical condition and the consequences that may result without a safety bed that addresses their specific needs.
6. Recommendation / Request: This section should be a conclusion to your arguments stating that the specific product from Beds By George satisfies the needs. It is mandatory that you specifically summarize how BBG features address the dangers you highlighted. Your final closing should always be a restatement of your conclusion in the form of a specific product request, thanking the reader for his consideration.
The information on this page is opinion. We in no way guarantee insurance coverage nor reimbursement for our products. The information here is for informational purposes only and may or may not assist you in securing funding for medical equipment. It is in no way implied that if you follow these steps or use these examples you will be granted funding. Insurance coverage, application, circumstance, and policies vary. Be advised every case, every agent, and every insurance company is different. We strongly recommend that you communicate with your provider(s) and research other sources for information as well.
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To Whom It May Concern:
Rachel Johnson is a 6 – year old girl with 1P36 Deletion Syndrome. She has moderate global developmental delays and suffers from microcephaly, apraxia, low muscle tone in both upper and lower extremities, scoliosis, night time seizure activity and many symptoms commonly found in autism. The combination of conditions makes her especially unsteady when tired or just waking up. She is mobile with supervision. She is incontinent in bowel/bladder. She is almost completely non-verbal. She has outgrown in both weight and length the safe use of a crib. She is in need of an adaptive or safety bed for both her safety and development.
When her parents had her in a bed without protective sides she has fallen out of bed. She does not have the muscle tone nor cognitive skills to stop herself from falling out. In addition it is unlikely that should she become even moderately trapped or entangled would she be able to extract herself or prevent injury. Further, her global delays coupled with the inability to talk make her unable or unlikely to call for help in an emergency situation. The FDA has determined that 77% of entrapment or entanglement circumstances result in either injury or death among frail or handicapped persons.
We have researched the available products with the assistance of her physician. She needs a safety or adaptive bed that is designed for someone her size and larger, that will protect against entrapment and entanglement, that will prevent falls from bed, and that minimizes the likelihood that she will climb over the rails.
Beds by George manufactures an adaptive / safety bed called the H1000F that meets these needs. Their bed provides fall protection, satisfies the FDA’s 7 Zones of Entrapment standard; is a full twin size bed, has 22" tall climb resistant doors / rails; is in alignment with the “inclusion” philosophy for developmental integration; and satisfies the anti-enclosure standard supported by Medicaid, The Commission on Quality of Care for the Mentally Disabled, and The Division of Quality Assurance of the Office of Mental Retardation and Developmental Disabilities.
As you will agree the Beds by George H1000F bed is the ideal product to satisfy the medical need for Rachel. Thank you in advance for your consideration and prompt attention.
Sherri Laird, PTR