Examples of Letters of Medical Necessity

If you’re looking to make a health or wellness purchase outside of the scope of standard HSA eligibility, you’ll need a Letter of Medical Necessity. If you’ve never received one before, you may be curious about what it is. Here’s a medical necessity letter example, along with some other important information about Letters of Medical Necessity and how they work. 

What Is a Letter of Medical Necessity?

There are two types of Letters of Medical Necessity. One is for your HSA, and another is for your insurance company. There may be instances where you require one or both to have medical expenses appropriately covered or reimbursed — the Letter of Medical Necessity we’re focusing on is a letter allowing you to use your HSA for a purchase, but it’s helpful to know the difference.

Letter of Medical Necessity for Your HSA

A Letter of Medical Necessity is a letter written by a doctor stating that a health or wellness purchase is crucially important for their patient’s health. It’s a simple and straightforward letter addressed directly to your HSA custodian justifying making a special purchase that requires additional doctor approval.

Letter of Medical Necessity for Your Insurance Company

A Letter of Medical Necessity for your insurance company is a letter written by a doctor stating that your insurance company is required to pay for a specific product, treatment, or service that is, was, or will be completely medically necessary for your health. 

You’ll only need this type of Letter of Medical Necessity if your insurance refuses to foot the bill for an important test or specialist. It acts as a legal document to hold your insurance company accountable if they leave you with an unreasonable bill for life-saving care. 

Who Needs a Letter of Medical Necessity?

You don’t need a Letter of Medical Necessity for any purchase that’s specifically covered by your HSA outright. Things like copays on prescriptions or medical appointments and over-the-counter medicines are covered by default. You only need a Letter of Medical Necessity if you want to make a purchase that isn’t specifically listed as HSA-eligible. 

Your HSA eligibility can expand to include things like gym memberships, workout equipment, saunas, cold plunges, hot tubs, healthy foods, vitamins, and supplements if your doctor believes they’re necessary for your health. 

Before you purchase something outside of normal HSA eligibility with HSA funds, get a Letter of Medical Necessity first. 

How Do Letters of Medical Necessity Work With Your HSA?

A Letter of Medical Necessity serves as proof that you were allowed to buy something with HSA money. Your Letter of Medical Necessity combines with your receipt or invoice to show that you followed the HSA rules. 

You may need to submit copies of your Letter of Medical Necessity in conjunction with your receipts to avoid paying a tax penalty on purchases you made on your HSA account or reimbursed from your HSA account. 

Medical Necessity Letter Example

You shouldn’t need to provide your doctor with an example of a Letter of Medical Necessity. Your doctor has likely written one before and knows exactly how to present the information to your HSA holder. 

If you’re curious about what your Letter of Medical Necessity will look like, it will likely be similar to the following example. We’ve used a gym membership as the example for the letter, which your doctor will type on their official physician’s letterhead, and we’ve filled in the blanks with Star Wars characters. Please note that you cannot use this template to create your own Letter of Medical Necessity.

Policyholder: Jane Doe

Attention Example Medical Center:

I am writing on behalf of my patient, Jane Doe, to document that it is a medical necessity for Jane to treat her obesity with a membership to XYZ Gym.

This letter documents Jane Doe’s medical history and diagnosis and summarizes my treatment rationale. 

Please see the additional information enclosed with this letter.

Summary of Medical History and Diagnosis

Jane Doe is 30 years old and was first diagnosed with obesity on 01/01/3. Jane has been my patient since 12/01/2. 

Jane’s BMI is in the obese category, and she struggles with weight management. Her cholesterol is elevated, and she is at an increased risk for developing type 2 diabetes. I have spoken to Jane about making healthy lifestyle choices and changing her daily fitness routine. She would significantly benefit from a gym membership.

Rationale for Patient’s Treatment

Jane Doe lives in an apartment and doesn’t have space for home workout equipment. She has no foundation for self-starting a workout routine and would benefit from the gentle, low-impact workout equipment at XYZ Gym. Regularly working out at XYZ Gym can reverse her obesity, lower her cholesterol, reduce the potential of developing diabetes, and prolong her life.

In summary: A membership to XYZ Gym is medically necessary and reasonable to treat Jane Doe’s obesity, and I ask you to approve coverage of a membership to XYZ Gym for my patient.

You may review the enclosed documents, including Jane’s lab reports, official diagnosis, evaluation by obesity specialist Dr. ABC, and patient notes. Contact me at 867-5309 for further information.

I appreciate your consideration on behalf of my patient. 

Sincerely,

Dr. ABC, MD

(NPI Number)

Who Can Write Letters of Medical Necessity?

Your primary care doctor can write you a Letter of Medical Necessity, but they’re not the only doctor who can exercise that power. A nurse, nurse practitioner, psychiatrist, psychologist, occupational therapist, physical therapist, or chiropractor can also write you a valid Letter of Medical Necessity as long as the product or service they’re recommending is in line with the treatment you’re receiving from them. 

For example: a Letter of Medical Necessity from a psychiatrist recommending a healthy meal delivery service to treat obesity wouldn’t be well received because your psychiatrist is not in charge of treating your physical health. If your psychiatrist recommends that you practice aromatherapy to help you manage feelings of anxiety, they could write a Letter of Medical Necessity for an essential oil and diffuser kit. 

You may be able to write your Letter of Medical Necessity yourself, but it won’t be valid until your doctor endorses it and provides additional documents regarding your diagnosis and treatment plan. Since you need your doctor’s help anyway, it’s best to let them write it to begin with. Your doctor already knows exactly how to phrase the letter to validate your medical need. 

How Long Does a Letter of Medical Necessity Last?

It’s assumed that a Letter of Medical Necessity should last for the duration of your treatment program or plan. If your treatment doesn’t have a specified duration, your Letter of Medical Necessity is regarded as expired one year after it’s written. 

If you want to keep using or buying the product or service recommended in the letter, your doctor can write you a new letter. It’s important to stay on top of things to avoid a lapse in medical necessity coverage. If you know your gym membership is expiring in two months and you need a new Letter of Medical Necessity for HSA coverage, ask your doctor. 

What Do You Do With a Letter of Medical Necessity?

You can send a signed copy of your Letter of Medical Necessity to your HSA custodian. You may need to if you obtained your HSA through your employer. If you have an FSA rather than an HSA, you need to send your letter to your FSA custodian.

The most important thing to do with your Letter of Medical Necessity is to keep a copy in your patient file that your doctor manages and to keep a copy for yourself. You need a copy of your Letter of Medical Necessity to use in conjunction with your receipts. Your Letter of Medical Necessity acts as evidence that you spent your HSA funds appropriately. 

Your doctor should have a backup copy of your Letter of Medical Necessity in the event that you can’t locate yours. Just keep in mind that doctors are busy, and you may have to wait a while for your backup copy. There’s no guarantee that you’ll get it in time for your taxes if you ask at the last minute. It’s better to keep yours in a safe place, like a lockbox, with the rest of the receipts and documents you need for your taxes. 

A Letter of Medical Necessity Is an Empowering Tool

Your Letter of Medical Necessity will help you take control of your own wellness needs and make them more affordable through the use of your HSA/FSA funds. If you don’t have a Letter of Medical Necessity for a product or service you need, Truemed and our integrated retailers may be able to help.

We partner with many brands in the health and wellness space, including gyms. Our quick survey process for a medical evaluation can help you get the Letter of Medical Necessity you need without having to wait months for an appointment with your doctor. The process is simple and affordable, and the total cost of your medical evaluation is HSA/FSA eligible. We’re here to help you get healthy and empower yourself.

Sources:

What are HSA-eligible plans? | HealthCare.gov

About Publication 502, Medical and Dental Expenses | Internal Revenue Service

What Is a Psychiatrist | UCLA Med School

Essential oils for treating anxiety: a systematic review of randomized controlled trials and network meta-analysis | Frontiers in Public Health