Letter of Medical Necessity

Susanm · Post by **Susanm** » Fri Sep 07, 2007 6:40 pm

Is it the same as an xpap prescription? I've requested my prescription from the sleep center twice, and both times I've been sent my sleep study and a letter of medical necessity. Nothing that looked a a prescription per se. The letter has all the info on it, including the doc's signature, but no pressure. The page with the pressure and recommended mask etc, that was sent to the DME doesn't have a signature. The second time I called, I was very specific about needing the prescription as if it would be for a DME. Are the folks working in the office really kinda dim, or is one of those documents actually considered a legal rx? Or would they be an rx if combined, since they would then have all the pertinent info? Why the hell can't they make something simple for once?

Susan M

RosemaryB · Post by **RosemaryB** » Fri Sep 07, 2007 7:05 pm

Some DME's just use the letter and the setting from the study. I did get an actual prescription from my doc, who is my GP after he got the other stuff. I think it can vary.

Susanm · Post by **Susanm** » Fri Sep 07, 2007 7:18 pm

Thanks RosemaryB, that sounds hopeful. I'm going to try to borrow enough $$ from my mother-in-law to buy a cpap from our hosts here and was getting frustrated with my lack of progress in getting what looked like an rx. Sometimes it seems like the whole world is against the sleepy folks.

Susan M

Goofproof · Post by **Goofproof** » Fri Sep 07, 2007 7:28 pm

Prescriptions come from Doctors, they may say the same thing,but they are for different uses. Get your script from your Dr. Jim

Wulfman... · Post by **Wulfman...** » Fri Sep 07, 2007 7:40 pm

My understanding of the "letter of medical necessity" is for the situations in which there is some dispute with the insurance providers and/or the DMEs. For example, if the doctor prescribes an Auto or a Bi-PAP/Bi-level (or other specialized machine), so as to override the standard "you have to start with a CPAP" scenario.

Den

Susanm · Post by **Susanm** » Fri Sep 07, 2007 8:08 pm

[quote="Wulfman..."]My understanding of the "letter of medical necessity" is for the situations in which there is some dispute with the insurance providers and/or the DMEs. For example, if the doctor prescribes an Auto or a Bi-PAP/Bi-level (or other specialized machine), so as to override the standard "you have to start with a CPAP" scenario.

Den

In this case, insurance wouldn't pay for treatment unless my average AI was 11 or more an hour. The doctor had to write a letter saying mine was over that threshold. Mine is pretty mild when you just factor in the number of events ... but I stop breathing for a loooong time. It works out to about 17 minutes out of every hour spent not breathing. That's a lot of dead brain cells. Not that insurance cares.

Guess I'll have to bug them about that rx some more ... break it down and try to idiot proof the description of what an rx is.

Susan M

Goofproof · Post by **Goofproof** » Fri Sep 07, 2007 8:16 pm

Tell them to pretend it's for a bottle of pills, only have them call it a APAP w/A-Flex, With Heated Hudimifier, Set to a low of ___cm to a high of ___cm.

Quanity ONE EACH.

Mask to be decided by patient. Jim

Get the perscription in your hand, and use copies at suppliers. Good for life....

Wulfman... · Post by **Wulfman...** » Fri Sep 07, 2007 8:17 pm

Susan,

I'm sure there are a lot of situations where the letter would be needed.....I just rattled off a couple that came to my mind from some examples I've read about on the forum.

Good luck.

Den

Susanm · Post by **Susanm** » Fri Sep 07, 2007 8:30 pm

Wulfman... wrote:Susan,

I'm sure there are a lot of situations where the letter would be needed.....I just rattled off a couple that came to my mind from some examples I've read about on the forum.

Good luck.

Den

Oh, totally understood Wulfman ... I just thought it was ironic that the insurance company took it upon themselves to decide what was an appropriate "degree" of sickness that was worth treating, and that was roughly double what the medical community recognizes as needing treatment.

Susan M

Wulfman... · Post by **Wulfman...** » Fri Sep 07, 2007 8:36 pm

Susanm wrote:
Wulfman... wrote:Susan,

I'm sure there are a lot of situations where the letter would be needed.....I just rattled off a couple that came to my mind from some examples I've read about on the forum.

Good luck.

Den
Oh, totally understood Wulfman ... I just thought it was ironic that the insurance company took it upon themselves to decide what was an appropriate "degree" of sickness that was worth treating, and that was roughly double what the medical community recognizes as needing treatment.

Susan M

Oh, I've read those stories, too. It boggles the mind when they pay gazillions of dollars to treat the end results, but don't want to spend a little up front for preventive therapy.

Den

geoDoug · Post by **geoDoug** » Fri Sep 07, 2007 11:28 pm

Wulfman... wrote:I'm sure there are a lot of situations where the letter would be needed.....I just rattled off a couple that came to my mind from some examples I've read about on the forum.

FWIW, another good example: I had the doctor write up a letter of medical necessity for air travel. Luckily I've never had to use it, but I wanted something that supported the prescription, just in case TSA stopped me.

I have one also for other medication I take.

Doug.

Snoredog · Post by **Snoredog** » Sat Sep 08, 2007 12:43 am

Your GP doctor should have a copy of your PSG, they should write you a script from that. I would ask for a AFlex machine.

Mask

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