International Hyperhidrosis Society
 

Letter of Medical Necessity

Health insurance organizations in the U.S. or other third-party payers may not routinely cover some treatments for hyperhidrosis and/or they may require documentation of medical necessity when particular treatments are prescribed before deciding to pay for these treatments. Healthcare providers can adapt the following letter of medical necessity to provide documentation of your need for a particular therapy.

Sample Letter of Medical Necessity for Hyperhidrosis Treatment

[Date]
[Insurer name]
Attn: [Name of individual]
[Address]

re: [Patient name]
[Policy number]

Dear [Insurer name]:

I am writing on behalf of [Patient name] to document the medical necessity of [insert
treatment option here] for the treatment of hyperhidrosis. This letter provides information
about the patient’s medical history and diagnosis and a statement summarizing my
treatment rationale.

Hyperhidrosis, or excessive sweating, is a medical condition that can have a devastating effect
on a patient's quality of life, causing physical discomfort, secondary skin problems, social/emotional
sequelae such as anxiety and depression, and disruption of occupational and daily activities. This has 
certainly been true for [Patient name], who has been impacted by hyperhidrosis for [insert duration of symptoms here]. 
Specifically, [he or she] has had difficulties with [insert quality-of-life, social/emotional and/or career/daily living problems here].

[Discuss patient’s diagnosis, treatment history, and degree of illness]

[Insert patient's name] has tried the aforementioned therapies thus far without success and I, therefore, 
recommend [insert treatment option here] as the next logical choice for treating [his or her] 
hyperhidrosis.

In light of this clinical information, and this patient’s condition, [insert treatment option
here] is medically necessary and warrants coverage. Please contact me at [(000) 000-
0000] if you require additional information.

Sincerely,
[Physician’s name]

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