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Part of: Build your case

Doctor letter kit

Build a short note asking your doctor for a letter of medical necessity, with an outline they can work from.

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General information, not legal advice

What it asks, and what it is not

What it asks. The treatment, the denial reason, and what the plan's criteria ask for.

Everything you type stays in this browser tab. Nothing is sent anywhere, and no account is needed.

What it is not. It prepares a request and an outline. The clinical content must come from your clinician.

What does your doctor's office need to write?

Choose one above and the letter appears here.

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Open the letter you need

Each letter page shows the full text with highlighted blanks. Print it and write in the blanks by hand.

Note to your doctor's office
A short, courteous note to your doctor's office that says exactly what you need for your appeal, whether that is a letter, records, a call to the plan or a billing check, and by what date.
Letter of medical necessity (for your clinician to adapt)
A letter in your clinician's voice that explains the diagnosis, what has been tried, why the denied care is medically necessary for you, and what is likely to happen without it. Every clinical statement is a blank for the clinician to complete.
Step therapy exception letter (for your clinician)
A letter in your clinician's voice asking the plan to skip a required first-try drug because it has failed, is unsafe or is otherwise not right for you. Every clinical statement is a blank for the clinician to complete.
Off-label or experimental use letter (for your clinician)
A letter in your clinician's voice that responds to an experimental, investigational or off-label denial with the clinical reasons and the evidence for this patient. Every clinical statement is a blank for the clinician to complete.
Out-of-network necessity letter (for your clinician)
A letter in your clinician's voice explaining why in-network care cannot meet the patient's needs, so the plan should cover an out-of-network provider. Every clinical and network statement is a blank for the clinician to complete.
Certification of urgency (for your clinician)
A short letter in a physician's voice stating that the standard time frame could seriously harm the patient, so the plan must treat the claim or appeal as urgent and decide within 72 hours. Every clinical statement is a blank for the physician to complete.
Peer-to-peer call brief (for your clinician)
A one-page set of notes in your clinician's voice for a call with the plan's reviewing doctor: the three points to make, the questions to ask and what to record. Every clinical statement is a blank for the clinician to complete.

Private: nothing leaves this tab
General information, not legal advice

What it asks, and what it is not

What it asks. The treatment, the denial reason, and what the plan's criteria ask for.

Everything you type stays in this browser tab. Nothing is sent anywhere, and no account is needed.

What it is not. It prepares a request and an outline. The clinical content must come from your clinician.

Related guides and checklists

Guide

How to ask your doctor for a letter of medical necessity

Make it easy for your doctor's office to write a letter that answers the plan's reason for denying your care. Covers who to ask, what to hand over, when, and what to do if the office says no.
Guide

Peer-to-peer review and how to prepare your doctor

A peer-to-peer review is a phone call between your doctor and the plan's reviewing doctor. It is usually worth asking for early, but availability and timing vary by plan. Here is how to ask and prepare.
Guide

What a strong letter of medical necessity contains

A checklist for the letter your doctor writes, so it answers the plan's stated reason, uses the plan's own criteria, and gives the reviewer the facts needed to decide. For you to check the draft against.

Part of Build your case · Work with your doctor · My Plan