Explanation: Writing a Letter of Medical Necessity If a child with special medical condition/s requires a specialized car safety seat

or safety restraint, and the parent/s or caregiver/s desire to be reimbursed for the car safety seat, you will need to write a letter to the insurance carrier or Medicaid detailing justification for financial reimbursement. For children under 6 years of age, it is suggested that this letter have a greater focus on the child's positioning needs and medical necessity in addition to the legal need for a car seat. Remember: The Georgia code section only covers children under 6 years of age, therefore, a child 6 years of age or older in need of a special positioning car seat is not required by law to be in a car seat. For this reason, when requesting a seat for any child that is 6 years of age or older stress the medical and safety concerns. The parent/s or caregiver/s shall obtain a prescription from the doctor to see a Physical or Occupant Therapist to evaluate the child for a specialized car safety seat or safety restraint. The Letter of Medical Necessity shall be written by the Physical or Occupational Therapist and could include information from those individuals involved with the schools Individual Education Plan (IEP), transportation specialists, and other interested parties involved in ensuring safe transportation for this child. In the letter, describe the child and his/her medical condition/s. Be specific so that a third party payer understands the child's needs, how this special car seat will assist in this child's daily functioning and what will be accomplished by the use of this special car seat. For example, the child may need the seat to travel to medical appointments and school in order to safely position the child in a way that a conventional car seat cannot. This letter should include the following information: Date Child's name Age and date of birth Height and weight Primary/secondary insurance information Medical diagnosis Current level of functioning Medical history (including the child's physical/medical conditions that will be affected by the use of the recommended car seat, their range of motion, muscle tone, posture description, how much assistance is needed, etc.) How the child is currently transported in a vehicle Recommended car seat (name, model and a description of the special car seat including features and cost) Why this specific car seat was chosen The child's travel destinations/needs The expected outcomes from using this car seat Other medical equipment being used by this child Child's current therapy program including short-term and long-term goals Signatures with contact information (address and telephone numbers) Include a copy of medical evaluations highlighting the need for this seat and bes sure to include a doctor's prescription for the seat

EXAMPLE LETTER
Date: Letter of Medical Necessity RE: Childs Name DOB: To Whom It May Concern: I am writing to request that you please provide funding for a special needs car seat for Childs name. Childs first name is a ___ year-old male/female with a diagnosis of cerebral palsy and he/she demonstrates abnormal tone throughout his/her body. he/she has decreased sitting balance and head control and cannot sit up or hold his/her head up without support. Currently he/she is being transported in a store-bought car seat that does not provide him/her with adequate head and trunk support. Childs first name weighs 37 pounds and at 40 pounds he/she will outgrow the weight limits to use the harness in his/her current child safety seat. It is essential that childs name have a new adaptive car seat so that he/she may be transported safely. Childs first name was recently evaluated by the hospital staff, physical or occupational therapist. During the evaluation it was determined that childs first name requires a (include car seat make/model) Britax Traveler Plus adaptive car seat for safe transport in a motor vehicle. The Traveler plus car seat provides head, trunk, hip, and leg support for children like childs first name who have decreased head control and cannot sit up without support. Specifically, the Traveler Plus car seat has the following features that will ensure childs first name is safe during transportation: A reclining feature to allow childs first name to be seated in a reclined position which will accommodate his/her poor head and trunk control. An abductor wedge to prevent childs first name from sliding forward and sliding out of the car seat. A five-point harness that can be used until childs first name is105 pounds Head pads to support his/her head and prevent his/her head from falling side to side A tether system so the car seat is appropriately secure in the motor vehicle. A seat extender to prevent her legs from hanging over the side.

Thank you for considering childs first name needs. Your prompt response regarding this request would be greatly appreciated. If you have any questions regarding this request, please contact me at (list doctors contact phone number). Sincerely, (Name of the Physician who wrote the prescription for the car seat)