LMNs That Get Approved: 5 Takeaways Patients Need to Know

Taking good care of yourself and your family members can get expensive. This is especially true if you, or they, have underlying health conditions that require taking medications or supplements, using special equipment, or leveling up your lifestyle changes.

Some benefits accounts can help you offset costs related to your specific health needs, or those of your spouse or children or other dependents you claim on your tax return. These financial benefits include your health savings account (HSA) or flexible spending account (FSA).

You may be able to use your HSA or FSA dollars to offset the cost of various items or services if you’re using them to mitigate, treat, or prevent a specific medical condition. Here are some quick examples.

Maybe your doctor has recommended that you take a specific magnesium supplement to help prevent or ease migraine attacks. Or maybe your provider recommends using a red light therapy device to help address alopecia.

In some cases, you may need a letter of medical necessity (LMN) from a licensed healthcare provider to support that you require the product, service, or treatment for addressing your specific medical condition.

Eligibility depends on your plan’s rules, of course, along with other factors. However, LMNs that get approved tend to be detailed rather than generic.

In this article, we explore the factors that make a letter of medical necessity more effective and what you as the patient need to provide to your licensed clinician. Plus, we include how to get a letter of medical necessity.

A letter of medical necessity (LMN) is a formal document from a licensed healthcare provider that explains why a certain product, treatment, or service is necessary to treat, mitigate, or prevent your medical condition.

You might need an LMN if you desire to use your HSA or FSA dollars to offset the cost of a product, service, or treatment that is not automatically considered a qualifying medical expense.

The IRS provides some general guidelines for what constitutes a qualifying medical expense. These include dental and vision expenses, medical expenses (deductibles, copays, medications, etc.), family planning (e.g., contraception, fertility treatments, etc.), and medical travel (accessing necessary care in another state or at a specialty hospital, for example).

An LMN may be able to help you use your HSA or FSA dollars for even more health-related expenses. The letter helps substantiate potential eligibility.

An LMN must show that a product, service, or treatment is something you need for addressing your specific medical condition. It isn’t about just wanting a product or service—it’s about need.

You might be eyeing a stationary rower to add to your home gym. And you might intend to use that rower to improve your health. But your wants and your intentions alone won’t show medical need.

Your LMN must show that you need the product or service, whether a rower or something else, to mitigate, treat, or prevent a specific medical condition that you have.

For example, you have type 2 diabetes, and your provider recommends more movement to help control your glucose (blood sugar). Maybe they determine that using a stationary rower or bicycle is a safe and appropriate way for you to exercise. These details about your diagnoses help show that you have a medical need for the rower.

Your LMN must justify the why behind your product or service need. The letter might need to detail your symptoms and your medical history to help document why.

For example, maybe you have chronic obstructive pulmonary disease (COPD), but you live in a region with frequent exposure to smoke from wildfires.

Your provider might recommend that you purchase an air purifier for your home. Your LMN will need to detail your COPD diagnosis. It might include when you were diagnosed, your usual COPD symptoms, and how your condition can be exacerbated during times of higher pollution.

The letter might also include information on how air purifiers help reduce smoke exposure in your home.

In contrast, if your LMN just recommends an air purifier without detailing the reason behind the need, your plan might not approve the expense for FSA or HSA reimbursement.

You don’t need to know how to write a letter of medical necessity. A licensed clinician will do that for you. However, knowing what one needs to include can help you gather substantiating info.

Details help build credibility into your letter of medical necessity. So the more you can provide for documentation, the better. The licensed clinician writing your LMN may want to include some of the following info:

• Your personal information including your full name and date of birth.
• Your specific diagnosis and the corresponding ICD-10 code, which is an alphanumeric code used to classify diseases, symptoms, and procedures.
• Details about the recommendation, including what item, service, or treatment is needed. These details might include equipment model numbers, supplement dosages, etc.
• How long you need the product, service, or treatment. For example, maybe you need to take a specific supplement daily for six months.
• How the condition affects you, including how it impacts your daily life, your current symptoms, and more.
• Your treatment history, including what you’ve tried previously (along with treatment dates and durations) and whether those treatments were effective.
• Your supporting medical records, including assessments, lab work, imaging tests, and more that have been conducted in recent months and that are related to the specific medical condition noted on the LMN.
• Research info. Your letter might need to include links to clinical guidelines from various health agencies or peer-reviewed studies that support the need for the item or service as an effective intervention.
• Risks of denial. If your LMN is denied, how will the denial affect your health and care?

All the info mentioned above helps substantiate the need presented on the LMN. The licensed clinician writing your letter will handle some of this info on their own, but they may need to ask you questions or obtain medical records from you if they are not your regular healthcare provider.

Your LMN is only part of the file—not the whole file you need for getting approval for or reimbursement for using your FSA or HSA dollars. Here are a few things to keep in mind.

• Timing: Your LMN date, product or service purchase date, and submission timing should all meet your plan’s requirements.
• Documentation: Keep itemized receipts from your purchase or service payment and any additional documentation you receive.
• Check renewal requirements: If the item you need is something you need to keep buying, such as a supplement, you may need to renew your LMN yearly or after a certain period.
• Match names and details: Ensure that the LMN is using the same name and other details that are included on additional documentation, such as receipts or required forms.
• Be aware of deadlines: Your plan might have specific submission windows for reimbursement. This is especially a consideration with an FSA.

Ultimately your plan’s administrator has the final say in whether your LMN gets approved. The licensed clinician writing your LMN does not make this determination.

Plan rules vary, and even when documentation strongly shows your medical necessity for a certain product, service, or treatment, sometimes denials still occur.

However, providing as much substantiating evidence as possible for drafting an LMN helps support the case for approval.

Some common mistakes come up when patients request LMNs. Knowing these and avoiding them can help you receive a strong LMN to submit to your plan.

Mistake 1: Asking for a generic letter without a documented specific reason: Your LMN must document that you need the product, service, or treatment to address a specific medical condition.

Mistake 2: Assuming an online process means less documentation: Even if you’re handling the process of receiving an LMN virtually, you still need adequate documentation that substantiates your need.

Mistake 3: Treating the LMN as the only document worth saving: Your LMN is only one piece of the puzzle. You need to retain all documentation, including receipts.

Mistake 4: Confusing the receipt of an LMN as a reimbursement decision: The LMN does not guarantee that your plan will approve the use of your FSA or HSA dollars or reimbursement. That decision lies with your plan’s administrator.

As noted above, you might be able to purchase a product, service, or treatment with your HSA or FSA dollars if you’re using it to address a specific medical condition.

You might need a letter of medical necessity (LMN). Certain health products and services may be eligible for qualified customers with an LMN issued by an independent practitioner when the item is used to address a specific medical condition.

Truemed* specializes in helping you maximize your HSA and other health-related benefits (such as an FSA):

• First, you can check whether a product or service is normally considered a qualifying medical expense or whether you might need an LMN.
• Complete a health intake survey that will be reviewed by an independent licensed clinician.
• Buy the item; either pay directly with your HSA/FSA card at checkout, or pay with a regular credit/debit card and seek HSA/FSA reimbursement afterward.
• The independent licensed practitioner will review your medical history, and if you qualify, will issue an LMN. Truemed itself does not make eligibility determinations.
• Truemed also offers support in the event you get a denial of reimbursement and need to provide substantiation documentation.

*Truemed is for qualified customers. HSA/FSA tax savings vary. Learn more at truemed.com/disclosures