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Sample Letters of Medical Necessity

Sample Letters of Medical Necessity

Below you will find Sample Letters of Medical Necessity for various products. You can click to read the letter in a webpage format as well as download a pdf of the content.

Tip: Contact the beneficiary's insurance company and ask them to provide you with their definitions of medical necessity. Be sure to include all components in your letter while using the samples below as a general guideline.


Sample Letter of Medical Necessity for Special Tomato® Soft-Touch® Booster Car Seat

 

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Sample Letter of Medical Necessity for Special Tomato® MPS Car Seat

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Sample Letter of Medical Necessity for Special Tomato® Multi-Positioning Seat (MPS)

 

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Sample Letter of Medical Necessity for Special Tomato® Hi-Low Multi-Positioning Seat (MPS)

 

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Sample Letter of Medical Necessity for Special Tomato® Soft-Touch Sitter

 

Click here to view the letter in a webpage

 

Click here to Download the PDF