Shedding light on the letter of medical necessity

Defining "medical care"

For a product or service to be FSA-eligible, its primary purpose must be to treat, cure, diagnose or prevent a disease or illness. So a product like a first-aid kit is a no-brainer because they do not have a non-medical use.

However, there are many treatments and products that are not automatically eligible which may be eligible with a Letter of Medical Necessity to show that it was purchased for a medical purpose.

Here's an example: If your doctor suggests massage therapy to treat an injury, it's not FSA-eligible on its own. However, if you get an LMN from your doctor that outlines how the treatment method is essential to your recovery, your benefits administrator may accept it as an FSA-eligible expense.

How to submit a letter of medical necessity

If you and your doctor have identified a medical product or service that can aid the treatment of an injury or medical condition and it falls outside FSA eligibility, here's what you need to do:

• Check with your benefits administrator to see if there is an official form to fill out for the expense to be approved.
• If your doctor is writing a letter on his/her own, the letter must outline: what medical condition is being treated, a description of the treatment (frequency, dosage), and how long the expense will be needed to treat the condition.
• A receipt or invoice must be submitted with the LMN for the full price to be reimbursed.

Unlock more at FSA Store with an LMN

To eliminate the guesswork for you and unlock more potential for your tax-free funds, FSA Store is proud to now offer brands that make the LMN process easy. You can now access some of your favorite brands in just a few steps:

• Select the item you need: You will be taken to a third-party merchant for checkout.
• Pay using the FSA option: At checkout, be sure to select the FSA payment method.
• Take a brief medical questionnaire: You will need to answer some questions to determine if you qualify.
• Receive your LMN, pending approval: A licensed provider will review your answers. If approved, you will receive your LMN.
• Store your LMN and receipt: Submit these documents to your benefits administrator when requested.

To learn more about the LMN process at FSA Store, click here.

In some cases, benefits administrators may ask for additional information from your doctor, most likely for products/services that also have non-medical uses.

Keep in mind that beyond its direct medical use, most expenses are non-reimbursable if the individual would have purchased it anyway. In other words, this product can't be something you would purchase even if you didn't have the condition. It needs to be directly related to the course of treatment, and the specific use needs to be confirmed by a doctor or other medical practitioner.

One example is yoga. If you're already paying for yoga classes unrelated to a medical condition, your payments are not FSA-eligible, and these costs won't be covered retroactively. But if a physician recommends yoga to help a specific condition, an LMN may allow you to use tax-free funds to cover the costs of classes for a set period of time, until the doctor determines your treatment is complete.

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