Insurance Coverage for Fall Prevention

[Date]

[Insurance Company Name]
[Claims Department]
[Address]

Re: Request for Coverage of Home Safety Modifications

To Whom It May Concern,

I am writing to request coverage for home safety modifications to prevent falls for [Patient Name], date of birth [DOB], member ID [Member ID].

Based on a fall risk assessment conducted on [Date], [Patient Name] has been identified as at [High/Moderate] risk for falls. The following modifications are medically necessary to prevent injury:

1. [Grab bars in bathroom — estimated $XXX]
2. [Raised toilet seat — estimated $XX]
3. [Walk-in tub or shower modification — estimated $X,XXX]
4. [Other modifications as recommended]

Falls are the leading cause of injury among older adults. The CDC reports that one in four Americans aged 65+ falls each year. Home safety modifications have been shown to reduce fall risk by up to 40%.

I request that these modifications be covered under my plan's [Durable Medical Equipment / Home Health / Preventive Care] benefit.

Please let me know what documentation is required (prescription letter, doctor's note, home assessment report) to process this request.

Sincerely,

[Your Name]
[Phone Number]
[Email]