A letter of medical necessity is a document that is used to justify the need for certain treatments or services. It can be used to get insurance coverage for services like ABA therapy, or to prove to a school that a child needs special education services.
In this article, we will discuss how to write a letter of medical necessity for ABA therapy to send to an insurance provider, and what to include in it. We will also provide a sample letter of medical necessity.
How do you write a letter of medical necessity for ABA therapy?
There is no one-size-fits-all answer to this question, as the letter will be tailored to the specific needs of the individual. However, there are some general things that should be included in any letter of medical necessity for ABA therapy.
Some key points include:
State the nature of the illness
The letter should state that the individual has been diagnosed with autism spectrum disorder (or another condition that warrants ABA therapy).
Outline the treatment plan
The letter should list the specific goals of ABA therapy that will be addressed, and how they will benefit the individual.
Duration of treatment
The letter should state how long the treatment plan is expected to last.
Summary of letter
The letter should provide a brief overview of the main points that have been discussed.
Some other key aspects for a letter of medical necessity include:
- The letter should be on letterhead from a licensed health care professional such as a doctor.
- The letter should include contact information for the doctor.
- The letter should have a professional tone.
Sample letter of medical necessity for ABA therapy
Here is an example letter of medical necessity for ABA therapy:
To whom it may concern:
I am writing this letter on behalf of my patient, (Patient Name), to document the necessity of ABA therapy treatment. This letter offers information about their medical history, diagnosis, and an explanation for the necessity of treatment.
(Patient Name) has been diagnosed with ASD and currently exhibits symptoms that warrant ABA therapy. The most appropriate treatment here will be operant conditioning and positive reinforcement, which will help to program desired actions.
The rationale behind this treatment is that it’s totally safe. It is simply a positive reinforcement approach. It is just a method of rewarding patients for acting in a manner that is natural to them.
The patient will be left to engage in desirable behavior or else reinforcement incentives will be withheld unless there is a behavioral shift. This is about giving rewards or praise as the need arises.
The treatment plan will last for a total of 36 weeks, and will be supervised by myself or one of my associates. This will be repeated as necessary.
In summary, ABA therapy is a necessary and safe treatment for (Patient Name) that will address their specific needs. I urge you to approve this request and provide the coverage needed for ABA therapy. Please contact me if you have any questions.
Thank you for your time and consideration.
(your doctor’s name)
How Hidden Talents can help you
At Hidden Talents, we believe that ABA is the key to helping children on the autism spectrum succeed. Combined with the expert care and guidance of our trained BCBAs, your child can achieve more than you thought possible.
Reach out to us to learn more about how we can help.