Medical Note vs. Letter of Medical Necessity: How to Choose (and Win Approvals)

Every clinician has had this moment. You’re ready to submit a prior authorization for a much-needed medication and you hesitate. Should you attach your progress note? Or do you write a new Letter of Medical Necessity? CoverMyMeds doesn’t always specify, and insurance portals certainly don’t make it clear or easier for you to decide which is best.

So what happens? We guess. We upload too much or too little. We submit and cross our fingers and hope we’ve done enough. When it’s not, we get slapped with a delay, or worse, a denial that sets back treatment and burns through time you already don’t have.

There’s good news: it’s much easier to get it right. FightPaperwork.com does more than organize your submissions. It actually helps you figure out what information to include, then auto-generates the right format (medical note or letter) based on what the payer requires for an approval.

Let’s break down the difference between the two formats and develop a game plan on how to ensure you’re using the right one at the right time.

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Medical Note vs. Letter: What’s the Difference?

Medical Note (a.k.a. Progress Note):

• Structured (typically SOAP or similar)
• Captures full patient visit including HPI, exam, labs, plan of care
• Often pulled directly from EHR

Letter of Medical Necessity (LMN):

• Freeform narrative written for the payer—not another clinician
• Focuses only on why this specific service or medication is necessary
• Short, persuasive, and highly targeted

In short: A note documents care. A letter defends the decision behind that care.

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When a Note Works Fine

If you’re requesting something routine, like a formulary-approved medication renewal or a therapy that aligns perfectly with the payer’s criteria, a clear, recent medical note may be all you need to submit.

Example:

“Mr X is a 45-year-old male with moderate persistent asthma, managed on fluticasone/salmeterol. Continues to experience nighttime symptoms despite strict adherence. Using albuterol rescue >3x/week. Plan: Increase controller dose and re-evaluate in 6 weeks.”

This covers diagnosis, history, current status, and rationale. Attach that note and you’re likely good as you have hit on all the needed points.

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When a Letter is Better (or Required)

Letters come into play when the case isn’t so clear-cut:

• The patient failed first-line treatments
• You’re requesting an off-label use
• There’s a formulary exception or tier override
• There’s no recent note with all the necessary justification

In these cases, a brief but targeted LMN gives you a clean shot at approval, by telling the right story about the needs of the patient.

Example:

“This letter is to request approval for Ozempic for my patient, a 48-year-old woman with Type 2 Diabetes. Lifestyle modifications have been documented and sustained for 5 months. The patient has trialed metformin and glipizide without glycemic control. BMI is 39.4; HbA1c is 9.2%. Semaglutide is medically necessary due to both clinical efficacy and current ADA guidelines. Other GLP-1s have not been tolerated due to GI side effects.”

This is where you need to spell it out, not just for a clinician, but for a claims reviewer or pharmacist who may not read between the lines. It’s not long, but it hits every point: past treatment, failure, clinical status, and reason for request.

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A Quick Format for an LMN

If you’re not sure how to start a letter or feel stuck rewriting it each time, here’s a simple reusable structure:

1. Patient introduction:

   “This letter is to support the medical necessity of X, for Y, a # year old with a diagnosis of Z.”

2. Prior treatments & rationale:

   “The patient previously trialed X, with Y outcomes. Alternatives were not successful due to Z.”

3. Current clinical picture:

   “Patient continues to experience X, and requires Y as the next step in evidence-based care.”

4. Conclusion:

   “This request is consistent with clinical guidelines and is essential to prevent further deterioration in health.”

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The Real Challenge: Time

Even if you know which format you need, you’re still stuck with:

• Digging through EHR notes for the right phrases
• Rewriting letters from scratch
• Double-checking payer requirements
• Uploading and organizing everything manually

That’s what makes FightPaperwork.com different. After watching the latest demo, here’s what really stands out: the platform doesn’t just give you a space to upload paperwork. It helps you generate the right documentation, automatically. Correctly the first time.

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How FightPaperwork Takes the Guesswork Out

With FightPaperwork:

• You answer a few guided questions. What you’re requesting, what treatments have failed, key labs or metrics.
• The platform determines whether a note or letter is best for the situation based on your answers.
• It then generates the appropriate format, ready to download, edit if needed, and submit.
• You can even save versions of commonly used justifications to speed things up even more.

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Pro Tips for Success

• Don’t wait for a denial. Use FightPaperwork’s smart intake to anticipate payer requirements and submit the best document the right time, the first time.
• Always review the auto-generated note or letter. You know the patient best. Be sure to add that human touch before you hit submit.
• Pair documents when needed. A well-written letter alongside a recent note gives you double coverage, especially for requests that are not clearly black and white.
• Track your results. FightPaperwork helps you see which approaches get approvals fastest, so you can refine and reuse what works.

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Final Thoughts

CoverMyMeds wants a clear, well-documented case. Whether that’s in the form of a note or a letter depends on the clinical scenario, and the payer’s expectations.

But you don’t have to guess anymore. You don’t have to retype the same letter 50 times. And you definitely don’t have to settle for delays caused by “insufficient documentation.”

With FightPaperwork.com, you’re not just submitting paperwork. You’re submitting the right paperwork—tailored, formatted, and ready to win the approval your patient needs.

Let the platform do the formatting. You focus on the care.

Danielle Miller, RN
Doctorate-Level Nursing Expert | Healthcare Consultant | Academic Advisor