Letter of exception 2025

1. Click ‘Get Form’ to open the letter of exception in the editor.
2. Begin by entering the physician's letterhead at the top, including your name and contact information.
3. Fill in the recipient details: Name of Medical Director, Insurance Company, and their address.
4. In the subject line, clearly state 'RE: Patient Name', followed by the policy number and claim number.
5. Compose a brief introduction requesting a formulary exception for the specified treatment, ensuring to mention its medical necessity.
6. Outline relevant medical history and treatment rationale. Include sections for patient history, previous treatments, recent symptoms, and administration site rationale.
7. Provide a detailed rationale for treatment, citing published data and supporting documents as enclosures.
8. Conclude with your contact information and a polite request for timely response regarding approval.

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