prior-authorization-letter
Prior Authorization Letter Skill
A prior-auth or medical-necessity letter succeeds when it connects this patient's clinical facts to the insurer's coverage criteria — clearly, with evidence, and with the exact request spelled out. This skill structures that argument so the reviewer can approve it quickly, and so an appeal addresses the stated denial reason head-on.
Clinical-safety note: this is a documentation aid, not medical advice. The clinical justification must reflect the treating clinician's judgement and the patient's actual record; the clinician must review, verify, and sign before submission. Do not invent diagnoses, codes, history, or evidence.
Working from a brief
Given the treatment and a diagnosis, produce the full letter anyway — structure the argument and insert the standard elements, marking patient-specific facts (codes, dates, prior treatments) to be confirmed rather than inventing them. For an appeal, infer and directly rebut the likely denial reason if it's stated. Never fabricate clinical history or citations.