Diabetes Supplies Hardship Letter

{Name}
{Address}
{Phone #}

{Date}

Dear {insurance company}:

I am writing in regard to blood glucose test strips used to manage my {Type 1/2} diabetes. As evidenced by my attached insulin usage and testing history tracked by my {pump/program/doctor}, I routinely exceed the allotted number of test trips covered by your insurance company. While your company pays for {number} test strips per {time period}, I actually need {number} to adequately manage my disease.

As I'm sure you are aware, proper management of diabetes (including A1C levels) is the best way to reduce the chances of costly hypoglycemic events, emergency services, hospitalization, and so on.

I have been paying {amount} out of my own pocket for {number} additional test strips per {time period}. This has created a hardship for me, in part due to the {amount} I already must dedicate toward insurance premiums and uncovered medical expenses.

Please consider my hardship and legitimate medical need for additional test strips. I am currently using your preferred brand of {brand}.

Sincerely,

{Sender Name}

Enclosed: testing record, Dexcom printout, and note from Dr. {Name}

Index of Hardship Letter Examples