You may need a Letter of Medical Necessity (LMN, sometimes pronounced ‘lemon’) for the reimbursement of a procedure, product, or device when you use your health savings account (HSA) or flexible spending account (FSA).
What is a Letter of Medical Necessity?
Simply put, a Letter of Medical Necessity is a formal ‘letter’ from your doctor stating why you need a particular treatment, equipment, or service. It must link the request to a specific medical condition.
What’s in it?
In addition to information about you as a patient and the doctor, the letter will include information about your relevant medical history as a patient and
- Your medical condition or diagnosis
- How the requested treatment/equipment/service will either prevent, reduce, or mitigate the medical condition.
Who provides the Letter of Medical Necessity?
Benefit plan providers typically require a licensed healthcare professional to sign the letter. This is typically the physician treating you or your primary care physician. Contact your benefit plan provider for their specific requirements.
Can a nurse/physical therapist/occupational therapist write my Letter of Medical Necessity?
Yes, a healthcare provider can draft a letter of medical necessity as long as the requested benefit is directly related to the care they are providing. Contact your benefit plan provider to determine if they require your primary care physician to review and sign the letter.
Can I fill out my Letter of Medical Necessity?
You can provide information for your letter of medical necessity, but a licensed healthcare professional will need to complete and sign the form.
Is there a standard form, or template, for a Letter of Medical Necessity?
There is no universal template for a Letter of Medical Necessity, so they may look different depending on your plan and provider. Consult with your healthcare professional and benefit plan provider for specific requirements; however, the typical information required is:
- Patient Information: Patient’s name, date of birth, address.
- Provider Information: Name, credentials, NPI #, and contact information.
- Patient’s Diagnosis: Patient’s diagnosis or condition necessitating the recommended treatment.
- Recommended Treatment/Service: Description of the treatment, service, or equipment being recommended and why it is necessary. State how the recommendation is likely to improve the patient’s condition or prevent deterioration. State how the recommendation follows any established clinical guidelines or protocols.
- Supporting Information: Pertinent clinical evidence, such as test results or medical records.
- Failure of Alternative Treatments: Explain why alternative treatments are inadequate or ineffective.
Where can I find more information on Letters of Medical Necessity?
The U.S. Department of Labor has a good presentation on Letters of Medical Necessity.