The Letter of Medical Necessity as Genre: Who Creates It and Who Controls It

In this study, we analyze a small corpus of Letters of Medical Necessity and responses to those letters through the lens of Rhetorical Genre Theory. When all parties share an understanding of the relation between action and purpose, texts have a high probability of fulfilling their social purposes. However, as Carolyn Miller points out, there can be situations in which both parties in a communicative transaction believe a given genre exists, when, in fact, different understandings of the rhetorical situation undermine the success of that genre. Our analysis suggests that writers and evaluators often have differing understandings of the letter of medical necessity genre. We further find that writers of these letters, themselves, often have differing concepts of the letters' content and form. Thus, we suggest that those writing letters of medical necessity should engage in conversations about the needed content and form, and that providers and evaluators foster dialogue about the genre's key features.