Ready to put your HSA or FSA account to good use? You can use those pre-tax dollars for all sorts of qualified medical expenses, from doctor visits to prescription meds and medical equipment. But for things that fall outside of these standard medical expenses, or that could also be used for personal use, you’ll probably need a Letter of Medical Necessity, or LMN. 

We know what you’re thinking: another item on your to-do list (*groan*). But we’re here to make it easy with everything you need to know about LMNs, when you need one, how to get it, and what to do if it’s rejected.

The Expert

• Jeff Kreher, MD, FAAP, IFMCP, board-certified internist, sports medicine specialist, and functional medicine provider at PALM Health

What is a Letter of Medical Necessity?

A Letter of Medical Necessity (LMN) is a formal explanation from a doctor of the patient’s medical need for a certain product, treatment, or service. It confirms that the item or service is necessary to diagnose, treat, or prevent a medical condition. LMNs are typically used to attain insurance coverage, or to prove HSA/FSA eligibility.

In Dr. Kreher’s words, “LMNs are completed by a medical provider to demonstrate need for products or services that fall outside insurance coverage but may be reimbursable via HSA or FSA.”

Key Components

LMNs must be dated and typically include:

• The patient’s identifying information, including your full legal name, date of birth, and insurance identification number (if you have one)
• The healthcare provider’s information, including their :
  
  • Name
  • Credentials
  • Clinical affiliation
  • Official letterhead
  • National Provider Identified (NPI) number/medical license number, practice address
  • Practice contact info
• The medical diagnosis, a description of your condition, and an explanation of how the product or service helps this condition
• The required product, service, or treatment for the diagnosis and all relevant details, including dosage, treatment frequency, and product name
• A justification of medical necessity, providing clear evidence that the recommended product or service is crucial for your care, and how it will benefit your condition 
  
  • This section should include any and all supporting details, including clinical guidelines and research justifying the link between your diagnosis and the suggested product or service. 

When Do You Need an LMN?

One of the most common reasons for an LMN is to use pre-tax dollars from an HSA or FSA account for items that don’t automatically qualify.

“HSA/FSA accounts follow guidelines and coverage sources, such as IRS Publication 502, the HSA or FSA Store, and the HealthEquity Eligibility List,” says Dr. Kreher. “Providers are required to provide a diagnosis, medical necessity, and recommended item/service on the LMN to show medical need. If those requirements are not met, coverage through an HSA/FSA is not guaranteed.”

“Common requests are for OTC medications, medical devices, therapies, orthopedic items like braces or orthotics, weight loss programs, acupuncture care, chiropractic care, and psychological care,” adds Dr. Kreher. “Non-traditional items that athletes may seek coverage for include massage therapy, gym memberships, and dietary supplements. These may be covered if prescribed for a specific medical condition such as obesity, diabetes, acute or chronic pain, or a deficiency (i.e. vitamin D deficiency).”

When in doubt, always check with your HSA/FSA administrator to confirm which items qualify and which you need an LMN for. 

Other scenarios in which you might need an LMN include:

• You want to purchase products or services that aren’t typically covered by your insurance plan, like out-of-network services or off-label meds.
• You’re trying to overturn a denied insurance claim.

How to Get an LMN, Step by Step

So you’ve checked with your plan administrator and need an LMN to make your purchase. What now? There are two routes to take: call up your doctor, or use a platform like Truemed to complete the process online. 

Option 1: Get an LMN From Your Doctor.

To go the traditional route, you can request an LMN from your physician. If you don’t have an appointment coming up, you can try requesting one via email or phone call, or during a telehealth appointment. Once you receive the LMN, you can make your purchase and submit the LMN with an itemized receipt to your account administrator for reimbursement. 

Option 2: Use an Online Platform, Like Truemed or Flex.

If you’re looking for a quicker way to get an LMN (that doesn’t require getting up from the couch), you can use an online platform like Truemed or Flex, which provide LMNs (often within mere hours) through an online questionnaire. These sites have similar processes; here’s how it works for Truemed:

1. Head to a Truemed-partnered side (like Stridekick!) to shop for HSA/FSA-eligible wellness products, from fitness equipment to protein powder to supplements and more. If you shop with Stridekick, you’ll be redirected to your chosen product’s website for checkout. 
2. At checkout, select “Pay with HSA/FSA” to be redirected to Truemed’s survey. 
3. Complete the online health survey to be reviewed remotely by a physician (no in-person visit necessary). You can expect to receive your LMN within 24 to 48 hours, at max.
4. Use your HSA/FSA card to pay for your goodies, and submit the LMN along with the receipt to your administrator for reimbursement. 

My LMN Was Denied: Now What?

Sadly, LMNs aren’t automatically approved, and some get denied by the insurance provider. But a rejection isn’t the end of the road; you can still appeal the decision. 

Common Reasons for LMN Denial

• The product or service was determined to be for personal, general, or cosmetic use, not for the provided diagnosis
• The letter lacks essential details, like a diagnosis or supporting evidence to establish medical necessity
• The letter is dated after the purchase or outside of the FSA plan year

Your request for an LMN from a platform like Truemed might be denied if there’s a lack of supporting evidence proving that the product or service is medically necessary for the diagnosis, or if your questionnaire was incomplete.  

Appealing a Denial

If your claim is denied after submitting an LMN, acting fast will help strengthen your appeal and improve your odds of success. 

1. First, know that you have the right to request a denial explanation. The complete denial letter should provide a clear reason, clinical criteria, and the required steps to appeal, including a deadline. 
2. Contact your doctor, as their involvement will significantly up your chances of success. They can provide a supportive statement, including detailed evidence as to why the product or service is medically necessary for your diagnosis. 
3. In your appeal letter, directly reference relevant sections of your policy, word-for-word, and express how your diagnosis impacts your daily life. 
4. If the internal appeals process fails, you might have the right to an external review from an independent third party.

FAQs

• How long are letters of medical necessity valid for?
  
  • 12 months, in most cases
• Can I write my own letter of medical necessity?
  
  • No, it needs to be written and signed by a licensed healthcare provider.
• Does an LMN guarantee HSA/FSA approval?
  
  • No, your insurance provider can still deny coverage if they believe the purchase doesn’t fall within policy guidelines. 
• How hard is it to get an LMN?
  
  • With platforms like Truemed, you can get an LMN online (often within hours) without having to call your doctor or attend an in-person appointment. 

If you’re ready to get started, browse Stridekick’s HSA/FSA Shop to find products from leading brands in fitness, nutrition, sleep, recovery, supplements, and beyond. We’re partnered with Truemed to help you secure an LMN in a snap. Happy shopping!