The chronicle of a lonely do-gooder family doctor who survived.

Wednesday, July 23, 2008

Letters of Medical Necessity

People, this is what it has come to:

July 23, 2008

To Whom It May Concern:

I am the primary care physician for Mr. X. He has a history of intracranial hemorrhage (“bleeding in the brain”). This is usually a bad thing for patients and in Mr. X's case it has resulted in permanent paralysis (“inability to move”) on the left side of his body as well as cognitive deficits (“he doesn’t remember things well or have good judgment about things”). This occurred 2 and half years ago and his status has not improved since your company began insuring Mr. X, nor is it expected to change. His previous equipment was given to him in the hospital and has deteriorated from daily use over these years and is no longer safe for him to use. In fact, he has been living in bed since your company denied my previous prescription for new equipment.

As you might imagine, with a paralyzed half of the body, it is quite difficult and unsafe for someone like Mr. X to be walking around town. He would be prone to falling over and hurting himself almost immediately after support is taken away. Nevertheless, we generally recommend that these patients try to get out of the house, as laying around in bed all day carries a number of other medical risks and does not help one’s general state of well being.

So you can see the conundrum we in the medical community face when approaching these patients. Fortunately, there is a relatively new technology that allows these patients to be easily and safely moved around their homes and in fact outside in the community. We affix wheels to chairs (or a “wheel-chair” if you will) and we find this helps our patients a great deal in achieving some independence and reducing the sores, blood clots, and infections associated with confinement to beds. I think he would still require someone to help him move around in the wheel-chair but I think he would spend most of his day in the chair, clearly more than 8 hours.

I would like very much to have Mr. X's medical insurance pay for one of these devices but I am told that he would need a letter with a clear explanation of the equipment and spelling out exactly how he would benefit from a wheel-chair. This, in addition to the written prescription and the forms I have already filled out. I hope I have succeeded with this communication. If so, the 45 minutes of unpaid time I have spent talking with the medical supply company and composing this “letter of medical necessity” will have been well worth it for this unfortunate man. Thank you.

Dr. Sour Puss, M.D.