The Medical Necessity Letter

Draft a letter establishing medical necessity for [TREATMENT /
DEVICE / MEDICATION / PROCEDURE].

Payer: [INSURER / SCHEME / FUND]
Payer's stated criteria: [PASTE CRITERIA IF AVAILABLE]

Clinical justification (de-identified):
[PASTE YOUR REASONING AND RELEVANT HISTORY]

Structure the letter to:
1. State the requested item and the specific criterion it meets,
   in the first paragraph
2. Map each of the payer's criteria to the specific clinical facts
   that satisfy it — one by one, in their order
3. Document what has already been tried, with duration and
   outcome for each
4. State the expected clinical benefit and how it will be measured
5. State the consequence of non-approval in clinical terms
6. Reference the applicable guideline by name

Rules:
- Use only clinical facts I have supplied
- Do not invent trial durations, prior treatments, or outcomes
- Do not cite specific studies unless I supply them
- Keep it under [WORD COUNT] — reviewers read the first paragraph
  and skim the rest, so front-load