The Aphasia Center
TEMPLATE FOR MEDICAL NECESSITY LETTER
To be written on physician’s letterhead
Date
To Insurance Company,
Bob Smith is under my primary care at name of physician’s office or rehab. Mr. Smith sustained a traumatic brain injury/stroke, etc. on date. As a result of this, Mr. Smith now experiences list physical and mental issues associated with brain injury. Note severity of aphasia or cognitive deficits. Mr. Smith needs to improve his communications kills as much as possible. He has the potential to continue his recovery and improvement if he is provided the necessary and proper speech-language therapy services.
This letter and the certification form serve as a prescription for the speech-language therapy services provided at the Aphasia Center, LLC. The intensive nature of this specific program is required due to Mr. Smith’s significant language impairments. Research has consistently shown that intensive aphasia treatment produces significantly better outcomes than traditional therapy schedules. Language aspects to be addressed in this program would include expression speech and language, receptive language skills, multimodal communication, naming and word retrieval, and possibly reading and writing activities.
Mr. Smith is motivated and dedicated to ongoing improvement. He is a good candidate for intensive therapy. An intensive aphasia program is the medically necessary next step in his continuum of care for neurological rehabilitation. The program at the Aphasia Center, LLC can provide the necessary therapy approach and intensity for progress to occur.
Thank you for your consideration for Mr. Smith’s ongoing medical and rehabilitative needs, and for your approval of these critical services.
Sincerely,
Physician’s name
Address
Phone number
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