Читать книгу Dental Letters: Write, Blog and Email Your Way to Success with CD-ROM - American Dental Association - Страница 20

Date

Insurance Carrier Street Address City, State Zip

Re: Patient Patient Date of Birth Patient Insurance Company ID Number

Dear [Insurance Company]:

I am writing to request authorization for [patient] to receive treatment for the diagnosis of [condition]. This treatment is medically necessary to treat the specific medical condition described below. It is not in any way for general health and is not for cosmetic purposes to improve appearance.

The treatment will, or is reasonably expected to, prevent the onset of an illness, condition, or disability. [Provide diagnosis details below.]

OR

The treatment will, or is reasonably expected to, reduce or ameliorate the physical, mental, or developmental effects of an illness, injury, or disability. [Provide diagnosis details below.]

Should you require further information, please do not hesitate to contact my office at [office number].

Sincerely,

Dentist