Is your dentist telling you that braces are not just for looks? Do you need them for health reasons? Then you might need a “Sample Letter To Unitedhealthcare Requesting Medically Necessary Orthodontia.” This letter asks Unitedhealthcare to cover your braces. It is used when your dentist believes braces will fix serious dental problems.
Getting Unitedhealthcare to pay can be tricky. We can help you with this! We will share letter templates in this article.
These samples make writing easy. You can change them to fit your needs. Let’s get started and make the process simpler.
Sample Letter To Unitedhealthcare Requesting Medically Necessary Orthodontia
[Your Name]
[Your Address]
[Your City, State, Zip Code]
[Your Phone Number]
[Your Email Address]
[Date]
UnitedHealthcare
[Insurance Company Address]
[Insurance Company City, State, Zip Code]
Re: Prior Authorization Request for Medically Necessary Orthodontia
Patient Name: [Patient’s Full Name]
Patient Date of Birth: [Patient’s Date of Birth]
UnitedHealthcare Insurance ID: [Patient’s Insurance ID Number]
Group Number: [Group Number, if applicable]
Dear UnitedHealthcare,
I am writing to request prior authorization for orthodontic treatment for my [son/daughter/dependent], [Patient’s Full Name]. After a thorough examination, [Patient’s Name]’s orthodontist, Dr. [Orthodontist’s Last Name], has determined that orthodontic treatment is medically necessary to correct a severe malocclusion that is significantly impacting [his/her] health and well-being.
[Patient’s Name] suffers from [Specific Condition – e.g., severe overbite, open bite, crossbite]. This condition causes [Specific Problems – e.g., difficulty chewing, jaw pain, speech impediments, increased risk of dental trauma]. Dr. [Orthodontist’s Last Name] believes that without orthodontic intervention, these problems will worsen and lead to more serious health complications in the future.
Attached to this letter, you will find a detailed treatment plan from Dr. [Orthodontist’s Last Name], including diagnostic records such as X-rays and photographs. The treatment plan outlines the specific orthodontic procedures required to correct [Patient’s Name]’s malocclusion and alleviate the associated health problems.
I understand that orthodontic treatment may not always be covered by insurance, but in [Patient’s Name]’s case, the treatment is medically necessary to address a significant health issue. I urge you to carefully review the attached documentation and approve this request for prior authorization.
Please contact me at [Your Phone Number] or [Your Email Address] if you require any additional information. Thank you for your time and consideration.
Sincerely,
[Your Name]
How to Write Sample Letter To Unitedhealthcare Requesting Medically Necessary Orthodontia
1. Crafting a Compelling Subject Line
The subject line is your initial foray. It needs to be direct, yet informative. Avoid ambiguity; be forthright about the letter’s purpose.
- Example: “Prior Authorization Request – Medically Necessary Orthodontia – [Patient Name] – [Member ID]”
- Mentioning “Prior Authorization” streamlines the process.
- Include the patient’s name and member ID for swift identification.
2. A Respectful Salutation
Begin with a formal greeting. This displays deference and professionalism.
- Preferred: “Dear UnitedHealthcare Prior Authorization Department,”
- Avoid generic salutations like “To Whom It May Concern” if possible.
- If a specific contact person is known, use their name.
3. Introducing the Predicament
The opening paragraph should succinctly outline the reason for your correspondence. State the patient’s need for orthodontia and emphasize its medical necessity, not cosmetic desirability.
- Clearly state that you are requesting prior authorization for medically necessary orthodontic treatment for [Patient Name].
- Briefly mention the patient’s age and the pertinent diagnosis (e.g., severe malocclusion).
- Allude to the detrimental effects of the condition, such as impaired chewing or speech difficulties.
4. Delineating Medical Necessity with Precision
This section is the nucleus of your letter. Substantiate the medical necessity of the orthodontic treatment.
- Provide a detailed description of the patient’s malocclusion or dental irregularities.
- Cite specific diagnostic findings, such as cephalometric analysis, panoramic radiographs, and clinical evaluations.
- Explain how the malocclusion affects the patient’s oral health, function, and overall well-being (e.g., temporomandibular joint dysfunction, increased risk of dental trauma).
- Include a statement from the treating orthodontist affirming the medical necessity and outlining the proposed treatment plan.
- Reference any relevant medical literature or clinical guidelines that support the need for orthodontic treatment in similar cases.
5. Enclosures: The Supporting Arsenal
List all appended documents. This showcases thoroughness and aids in expediting the review process.
- Itemize each enclosure: “Orthodontist’s Report,” “Panoramic Radiograph,” “Cephalometric Analysis,” “Photographs of Patient’s Dentition,” etc.
- Ensuring that every piece of evidence is accounted for eliminates potential delays.
6. Expressing Anticipation and Contact Information
Conclude by expressing your expectation of a favorable response and providing contact details for any clarifications.
- State your expectation for a prompt and positive response to your prior authorization request.
- Provide your phone number and email address for easy communication.
- Offer to provide any additional information or documentation that may be required.
7. Sign-Off with Etiquette
End the letter with a polished closing.
- Use a formal closing, such as “Sincerely,” or “Respectfully,”.
- Type your full name beneath your signature.
- Include your credentials (e.g., MD, DDS) if applicable.
Frequently Asked Questions: Sample Letter Requesting Medically Necessary Orthodontia from UnitedHealthcare
Navigating insurance coverage for orthodontia can be complex. This FAQ section provides guidance on writing a sample letter to UnitedHealthcare requesting coverage for medically necessary orthodontic treatment.
What constitutes “medically necessary” orthodontia?
Medically necessary orthodontia typically addresses severe functional impairments, such as difficulty chewing, speaking, or breathing, that are directly caused by a significant malocclusion (misalignment of teeth).
What information should be included in the sample letter?
The letter should include the patient’s name, date of birth, UnitedHealthcare policy number, a clear statement requesting coverage for medically necessary orthodontia, a detailed description of the functional impairment, supporting documentation from a qualified orthodontist, and contact information.
What supporting documentation is needed?
Supporting documentation usually includes a comprehensive orthodontic evaluation, including cephalometric radiographs, photographs, and a written narrative explaining the diagnosis, prognosis, and the impact of the malocclusion on the patient’s oral health and function.
Where should the sample letter be sent?
The letter should be sent to the address specified by UnitedHealthcare for pre-authorization or claim submissions. Consult your policy documents or contact UnitedHealthcare directly to confirm the correct address.
What if my request is denied?
If your request is denied, carefully review the denial letter for the reason. You may have the option to appeal the decision by providing additional information or clarification to support your claim of medical necessity.
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