What Is a Letter of Medical Necessity?
A Letter of Medical Necessity (LMN) is a note from your healthcare provider explaining why a particular medical expense or service is needed for the treatment or management of a specific medical condition. This letter is often needed to substantiate claims for reimbursement through Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs), or Health Savings Accounts (HSAs).
Why Are Letters of Medical Necessity Needed?
FSAs and similar accounts follow IRS rules, which say that some products, services, or procedures are only eligible for reimbursement if a healthcare provider has verified that they are medically necessary. A Letter of Medical Necessity serves as documentation that your expense is related to the diagnosis, treatment, or prevention of a medical condition, distinguishing it from general health, cosmetic, or personal items that are not eligible. Without a Letter of Medical Necessity, claims for these expenses may be denied.
AI-Generated Letters of Medical Necessity
You may have noticed that some companies now offer Letters of Medical Necessity that are generated by artificial intelligence and then signed by a provider who is contracted with the company selling the product or service. While these AI-generated LMNs may be valid for certain purposes, it is important to note that not all employers accept them as documentation for FSA or HRA reimbursements. If your employer does not accept AI-generated LMNs, you will need to either use the Vita Letter of Medical Necessity template or request that your personal healthcare provider write a Letter of Medical Necessity for you.
Required Elements of a Letter of Medical Necessity
Patient Information: Your full name, date of birth, and any relevant medical details.
Diagnosis: The specific medical condition or diagnosis requiring the treatment or product.
Recommended Treatment or Service: The recommended treatment or service must be specific. The LMN should clearly identify the exact product, procedure, or service being prescribed. For example, a letter that lists the treatment or service as “products and services such as a membership, diagnostics, and supplements from ABC Company” is not sufficient. The LMN needs to name the specific product or service that is medically necessary.
Medical Necessity Explanation: The provider should describe how the treatment or product will help with your condition.
Provider Information: Full name, credentials, contact information, and signature of your healthcare provider.
Date: When the letter was written.
How to Submit a Letter of Medical Necessity
To get reimbursed, submit your LMN along with the claim documentation for your expense. Make sure the letter is complete, signed, and dated by your healthcare provider. If you have any questions about what expenses require an LMN or how to submit one, our Concierge team is always happy to help!
Frequently Asked Questions
Do I need an LMN for all medical expenses?
No. Only certain expenses require an LMN, such as those for general health or with dual purposes (medical and personal). If you have any questions about what expenses require an LMN, take a look at our Eligible Claims Guide.
How long is an LMN valid?
An LMN is generally valid for one year from the date of signature.
Can I use a template?
Absolutely! We offer an LMN template, but remember the letter has to be filled out, signed, and dated by your healthcare provider.
Questions & Support
If you need more advice or a template, please reach out to Vita Concierge at the contact information below. We’re here to make sure you get the most from your Flexible Spending Account and have a smooth reimbursement experience!
Vita Concierge
Monday – Friday, 5:00 a.m. – 5:00 p.m. Pacific
(650) 966-1492 | help@vitamail.com