Helping women touched by cancer become mothers.
Letter of Medical Necessity

Insurance companies use medical necessity to review benefits coverage and/or provider payment for services, tests or procedures that are medically appropriate and cost-effective for its members. According to United Healthcare’s website, “The Medical Necessity process is based upon a foundation of evidence-based medicine and:

  • Provides an opportunity to address covered services at the individual level to support enhanced access to quality care for the member.
  • Utilizes generally accepted standards of good medical practice in the medical community.
  • Offers timely communication between health plans, members and providers to allow for prospective, concurrent and retrospective review as well as appeal rights for adverse determinations.”

A thorough letter that establishes Medical Necessity includes the following topics:

  • Patient name, date of birth and insurance number
  • Patient diagnosis and diagnosis code
  • Cancer treatment plan
  • Side effects of the treatment plan associated with reproductive well-being
  • Proposed ICD-9 codes or V-codes you are requesting coverage for
  • Case for coverage
    • ASRM and ACOG Guidelines
    • Iatrogenic Condition
    • Right to Parity
    • Avoids Risk of Adverse Selection in Cancer Treatment
    • Physician signature
    • Your contact details

The following codes for standard fertility preservation treatments are useful in writing Letters of Medical Necessity: