What is a Letter of Medical Necessity? A Step-by-Step Guide
Navigating the healthcare system can be complex. One crucial tool in this journey is the Letter of Medical Necessity (LMN)—a document that plays a vital role in securing insurance coverage for treatments, services, and equipment.
This guide will explain what a Letter of Medical Necessity is, when you need one, and how to obtain one through Truemed. It will also cover key components, provide an example, and highlight common mistakes to avoid.
What Is a Letter of Medical Necessity?
A Letter of Medical Necessity is an official document from a licensed healthcare provider. It explains why a certain product, service, or treatment is important for a patient's health.
It is required to secure insurance coverage or use HSA/FSA funds for expenses beyond standard medical costs.
Types of Letters of Medical Necessity
1. For Your HSA/FSA
A Letter of Medical Necessity allows you to use your Health Savings Account (HSA) or Flexible Spending Account (FSA) for purchases that require additional approval, such as fitness programs, saunas, supplements, or cold plunges.
2. For Insurance Coverage
When an insurance claim is denied, a provider can send a Letter of Medical Necessity (LMN). This letter explains why a specific treatment, service, or product should be covered, even if it is not automatically included in the patient's plan.
Who Needs a Letter of Medical Necessity?
If you want to use your HSA or FSA for things not usually covered, like gym memberships, supplements, physical therapy, or alternative treatments, you should first check the rules. Not all expenses qualify, and some may need special approval. Make sure to keep records of your purchases in case you need to explain them later.
Keep in mind, to use your HSA or FSA funds you must obtain a Letter of Medical Necessity first.
Common HSA-eligible expenses requiring an LMN include:
- Fitness equipment & gym memberships
- Cold plunges & saunas
- Medical-grade supplements & vitamins
- Red light therapy
- Massage therapy
- Certain mental health treatments
If a treatment or product isn’t explicitly listed as HSA/FSA-eligible, an LMN is typically required. Truemed makes this process streigtfoward by handleing the LMN process for you and providing a market place to discuver products you can qualify for.
How to Write a Letter of Medical Necessity
A well-crafted Letter of Medical Necessity should be clear, concise, and persuasive. Below are the essential components:
1. Patient Information
- Full name, date of birth, and insurance ID
- Healthcare provider’s contact details
- Diagnosed medical condition
2. Medical History
- Explanation of the patient’s condition
- Previous treatments tried and their outcomes
- Why the requested treatment is necessary
3. Treatment Details
- The specific product, service, or therapy being requested
- How it will be used and administered
- Expected health benefits and outcomes
4. Justification of Medical Necessity
- Explanation of why this treatment is medically necessary
- Supporting evidence (clinical studies, treatment guidelines, or past effectiveness)
- Risks of not receiving the treatment
Example of a Letter of Medical Necessity
Your provider will draft your LMN on official letterhead. Below is a letter of medical necessity eample:
Policyholder: Jane Doe
Provider: Dr. ABC, MD
Patient Diagnosis: Obesity
Dear HSA Custodian,
I am writing on behalf of my patient, Jane Doe, to document the medical necessity of a gym membership at XYZ Gym as part of her treatment for obesity. Regular exercise will help lower her BMI, reduce cholesterol, and decrease her risk of type 2 diabetes. Given her lack of home workout space and structured fitness plan, a gym membership is essential for her health.
Sincerely,
Dr. ABC, MD
(NPI Number)
Truemed streamlines the Letter of Medical Necessity (LMN) process, making it easier for patients to navigate their healthcare needs. With Truemed, you don't need to worry about finding a template or drafting the letter yourself; their licensed providers handle all the necessary documentation for you. This not only saves time but also ensures that your LMN is compliant and tailored to meet the specific requirements of your insurance or HSA/FSA, allowing you to focus on your health without the added stress of paperwork.
Who Can Write a Letter of Medical Necessity?
A Letter of Medical Necessity must be written by a licensed medical provider who can assess and recommend treatment for the patient’s condition. This includes:
- Primary care physicians (MD, DO)
- Nurse practitioners
- Physical therapists
- Occupational therapists
- Psychologists (for mental health-related conditions)
How Long is a Letter of Medical Necessity Valid?
A Letter of Medical Necessity (LMN) is typically valid for a period of one year starting from the date it was issued. This means that if you receive a signed medical letter of necessity, it can be used to support your medical claims and needs for a full year. However, if you are undergoing long-term treatment or if your medical situation does not improve, you might need to obtain a new Letter of Medical Necessity each year. This requirement ensures that your healthcare provider can continue to justify the ongoing need for the specific treatment or services you are receiving.
How to Obtain a Letter of Medical Necessity with Truemed
Truemed simplifies the process of obtaining a Letter of Medical Necessity, ensuring a fast and hassle-free experience. Here’s how it works:
Make a purchase from a Truemed partner merchant.
Complete our quick medical intake survey on the same day as your purchase.
A licensed provider will review your information within 1–2 days. If approved, you’ll receive your LMN.
Use your LMN with your HSA/FSA for compliance and savings.
This process eliminates the need for traditional doctor appointments and makes it easier to access HSA-eligible health and wellness tools.
Common Mistakes to Avoid
When submitting a Letter of Medical Necessity, avoid these common mistakes:
❌ Omitting Key Information: Ensure the LMN includes the patient’s diagnosis, treatment details, and justification.
❌ Vague Language: Clearly outline why the treatment is medically necessary, not just beneficial.
❌ Lack of Supporting Evidence: Reference clinical studies or past treatment outcomes to strengthen the case.
❌ Not Keeping a Copy: Always retain a copy of your LMN for tax or reimbursement purposes.
Final Thoughts
A Letter of Medical Necessity is important for getting HSA/FSA reimbursements and insurance approvals. If you are a patient, provider, or caregiver, knowing what an LMN is and how to write a clear and effective LMN can help you get coverage for necessary health costs.
By leveraging Truemed’s streamlined LMN process, you can maximize your HSA/FSA benefits and take control of your health investments.