Use this sample letter requesting medical assistance as template for your formal request letter.
Last updated on June 27th, 2022
The most common reason people require financial support is because of the cost of the medication. However, money should not stop
an individual from getting the treatment they need. They can ask their doctor if there is another medicine that has the same effect but costs less.
There are public and private programs that offer assistance for people who need it by providing discounted or free medicines. These programs have requirements for eligibility to get assistance with medical costs that include the age and the income of the person asking.
Some programs require the patient’s doctor apply for them. However, the patient can also write a letter requesting medical assistance.
The main information that will need to be given on an application form to find out if the patient is eligible is:
- The name of the prescription medications including the name of each drug, the dose and how often it is taken
- The patient’s annual or monthly gross income
- The state in which they live
- The name of the patient’s insurance program if they have one
Programs that give assistance for seriously ill patients have an application form that should be completed. It can be submitted as well as a formal letter of request.
If the medicine and treatment cost more than the patient can afford and if they don’t have insurance, they may be able to negotiate a lower price. People who pay for their health care are often charged higher prices that people who have insurance. A letter requesting a lower price can be sent to the doctor or hospital.
Give Facts
The letter should contain as much information about the patient as possible such as Social Security number, account reference numbers if the letter is to an insurance company, the price of the medicine and the date it was prescribed by the doctor. It should not be generic and simply say the patient can’t afford the medicine.
It should give facts about the income of the patient and the cost of the medicine. The letter should be geared to the audience. It may be different if it is to a government agency than to a private institution.
Here is a sample letter requesting assistance. It should be
written in formal business-style and sent by certified mail, so the sender has a record of the time and date the letter was received. It can be sent to a government agency, private help association or to an insurance company. The sender should keep copies of all correspondence. Any enclosures should be copies and not original documents.
Sample Letter Asking for Financial Support for Medical Expenses
Sender’s Name
Sender’s Address
City, State, Zip Code
DATE
Receiver’s Name
Receiver’s Company or Institution’s Name
Receiver’s Address
City, State, Zip Code
RE: Requesting medical assistance for disease
Dear Name of Receiver,
This letter is to request assistance for purchasing the medications I need to treat [NAME of DISEASE]. The medicine was prescribed by my specialist [NAME of DOCTOR] on [DATE].
I was referred to your organization by my doctor because the medications I need to take for the rest of my life are too expensive for me to afford on my fixed retirement income. I understand that you give assistance to people who are eligible either by helping them pay for their medications or with free or very low-cost medicines.
I have completed the application form on your website and enclose a copy of it here. I have also enclosed a letter from my doctor stating that the medicine is required for me to continue my everyday activities.
Also, I have enclosed a copy of my medical record regarding my disease including a copy of the prescription and my last three bank financial statements. As you can see, the cost of the medicine, which is COST, is a very high percentage of my monthly income.
Thank you for your attention to this matter. I can be reached at 555-123-4567 or at [email protected] if you have any questions or require more information. I hope to have a favorable reply from you soon.
Sincerely,
Signature of Sender
Printed Name of Sender
List of enclosures
By Andre Bradley
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