Health insurance organizations in the U.S. or other third-party payers may not routinely cover some treatments for vitiligo and/or they may require documentation of medical necessity when particular treatments are prescribed before deciding to pay for these treatments. Healthcare providers can adapt the following letter of medical necessity to provide documentation of your need for a particular therapy.
[Date]
[Insurer name]
Attn: [Name of individual]
[Address]
re: [Patient name]
[Policy number]
Dear [Insurer name]:
I am writing on behalf of [Patient name] to document the medical necessity of [insert treatment option here] for the treatment of vitiligo. This letter provides information about the patient’s medical history and diagnosis and a statement summarizing my treatment rationale.
Vitiligo, or the depigmentation of skin and hair, is a medical condition that can have a devastating effect on a patient’s quality of life, causing physical discomfort, secondary skin problems, social/emotional sequelae such as anxiety, and depression, and occupational and relationship challenges. This has certainly been true for [Patient name], who has been impacted by vitiligo for [insert duration of symptoms here].
Specifically, [he or she] has had difficulties with [insert quality-of-life, social/emotional, and/or career/daily living problems here].
[Discuss patient’s diagnosis, treatment history, and degree of illness]
[Insert patient’s name] has tried the aforementioned therapies thus far without success and I, therefore, recommend [insert treatment option here] as the next logical choice for treating [his or her] vitiligo.
In light of this clinical information, and this patient’s condition, [insert treatment option here] is medically necessary and warrants coverage. Please contact me at [(000) 000-
0000] if you require additional information.
Sincerely,
[Physician’s name]
Text from this page is adapted from the International Hyperhidrosis Society www.SweatHelp.org.