Letter of Medical Necessity: How It Can Help You Get Recommended Products or Treatments
Key takeaways:
A letter of medical necessity (LOMN) is a document from your healthcare provider recommending a particular treatment, product, or device for medical purposes.
The letter often includes relevant patient history and information about the medical necessity and duration of the treatment being recommended.
You may need an LOMN for the reimbursement of a procedure, product, or device when you use your health savings account (HSA) or flexible spending account (FSA).
Health insurance policies cover a wide variety of services and products, from healthcare provider visits to hospital stays, prescription medications, and medical equipment. But some items — such as vitamins, supplements, and exercise equipment — typically aren’t covered.
You can use your health savings account (HSA) or flexible spending account (FSA) to pay for certain expenses that aren’t covered by insurance. However, if the expenses are not considered qualified medical expenses by the IRS, you may need a letter of medical necessity, or LOMN, from your healthcare provider to verify that the products or services are necessary for your health.
What is the purpose of a letter of medical necessity?
A letter of medical necessity explains why your healthcare provider is recommending a specific treatment or product. This document verifies that the expense is for the diagnosis, treatment, or prevention of a disease or medical condition, rather than for general health purposes. If the expense does not meet this requirements, it will not be considered an HSA- or FSA-eligible expense by the IRS.
Search and compare options
Let’s say your doctor recommends that you take iron supplements to treat iron-deficiency anemia. You will need an LOMN to obtain reimbursement for the supplements when you use your HSA or FSA funds. These tax-advantaged accounts allow you to set aside pretax dollars to pay for qualified medical expenses.
When is a letter of medical necessity required?
You usually need a letter of medical necessity for medical procedures or products that are excluded from health insurance coverage. You may be asked for an LOMN from your:
You may also need an LOMN if you have an HSA and are taking deductions for medical expenses.
What are some items that require a letter of medical necessity?
It’s not always clear if a product or service is considered an eligible expense under an insurance plan or tax-advantaged account.
If you have insurance, it’s important to contact your provider to get a better idea of what’s covered under your plan. If you have an FSA or HSA, you can call your account custodian to determine if an expense would be approved for reimbursement. As mentioned, certain items may require a letter or medical necessity to be considered eligible.
Read more like this
Explore these related articles, suggested for readers like you.
Generally, items that are not on the IRS’ list of qualified medical expenses need an LOMN. Common examples of products and services that may require a LOMN include:
Baby formula
Counseling
Exercise equipment
Fitness trackers
Fluoride toothpastes and rinses
Medicare has its own version of an LOMN called a certificate of medical necessity. This is generally used for claims involving durable medical equipment (DME), such as:
Seat-lift mechanisms
Who writes a letter of medical necessity?
Generally, your healthcare provider writes and signs a letter of medical necessity. An LOMN can help improve the odds of reimbursement for a product or service. However, it doesn’t guarantee that an expense will be approved.
Some examples of healthcare providers that can write an LOMN are:
Physicians
The healthcare provider who writes the LOMN must be the person who is treating you. If you’re submitting an LOMN to your insurance company, it’s a good idea to ask if there’s a preference about what kind of provider submits the document.
What does a letter of medical necessity include?
Some insurance providers and FSA and HSA account custodians provide templates for letters of medical necessity. You can find examples of these templates and information about the requirements for submitting the forms on the websites of:
Generally, your healthcare provider needs to include the following information in an LOMN:
Your name and medical history
Your diagnosis
Reason why the product or service is needed
Duration of treatment
Date the letter was written
Their relationship to you, contact information, and signature
How do I use a letter of medical necessity?
The following is an example of when a letter of medical necessity would come in handy, what information it would likely include, and how you would submit it.
Suppose your body mass index (BMI) is 32, which is generally considered high, and you have had a high BMI for years. As a result, your healthcare provider recommends you get a gastric bypass, a surgery that reduces the size of the stomach and lowers caloric intake. But your insurance company requires a LOMN in order for the surgery to qualify for reimbursement. Your healthcare provider might include the following information in the LOMN:
A diagnosis of obesity
References to studies that show the effectiveness of gastric bypass surgery
Information about your attempts to lose weight through other means, such as taking weight-loss medication
Information about any chronic diseases your have, including diabetes, hypertension, or sleep apnea
The LOMN would then be submitted to the insurance company for review. If the claim is denied, you could submit an appeal.
Tips on how to write a letter of medical necessity
It’s important that an LOMN includes a detailed description of your medical condition, as well as the product or service being recommended. This means that your provider will need to include a thorough account of your medical history, including information about any past treatments you’ve tried.
Next, your provider will need to demonstrate why the product or service is necessary for diagnosing or treating your condition. To do this, they can provide information about relevant clinical studies and research. They must also state the length of time you’ll need the product or service.
An LOMN should not be phrased like a demand. The focus should be why a product or service is medically necessary.
How long is a letter of medical necessity good for?
If you need a product or service for longer than the time specified on an LOMN, you will need to get a new letter. If not, you may not get reimbursement for expenses incurred after the original time frame.
If an LOMN does not state a duration, it typically lasts for 1 year. After that, you will need to get a new letter.
The bottom line
A letter of medical necessity (LOMN) demonstrates that an expense is needed for medical purposes. Your health insurance provider — or your health savings account (HSA) or flexible spending account (FSA) custodian — may request an LOMN before reimbursing an expense.
An LOMN is typically written by your healthcare provider and includes information about your diagnosis and duration of treatment. It should also include the reason why a treatment, product, or service is needed. An LOMN does not guarantee that your expense will be approved. However, it can increase your chances of getting coverage or reimbursement for an expense.
Why trust our experts?
References
Association of Accredited Naturopathic Medical Colleges. (n.d.). What is naturopathic medicine?
CMS.gov. (2009). Certificate of medical necessity. U.S. Department of Health and Human Services.
Internal Revenue Services. (2023). Publication 502 (2022), medical and dental expenses.
Office of Inspector General. (n.d.). Osteogenesis stimulators: Lump-sum purchase versus rental. U.S. Department of Health and Human Services.
This article is solely for informational purposes. This article is not professional advice concerning insurance, financial, accounting, tax, or legal matters. All content herein is provided “as is” without any representations or warranties, express or implied. Always consult an appropriate professional when you have specific questions about any insurance, financial, or legal matter.
