How to get a Letter of Medical Necessity (LMN) online to use my FSA/HSA

We are only able to write your letter once you have joined, because joining establishes the ongoing medical relationship the letter requires. The $30 membership is charged when a provider approves your letter. You can cancel anytime and your membership stays active to the end of the current cycle, with no cancellation fees.

A provider-signed statement confirming an item or service is needed to prevent or treat a diagnosed condition. It is required when an expense could be for general wellness.

For HSAs, you generally keep the LMN with your tax records and use it if you’re ever audited. The IRS says to keep records supporting HSA distributions. HSA custodians typically don’t pre-approve whether a withdrawal is qualified. This is different from an FSA, which usually requires you to submit the LMN (and other documentation) to the plan for payment or reimbursement. Some HSA providers may ask for documents to help you maintain records, but the responsibility is on you, not the plan.

Your provider updates the LMN at no extra cost while your membership is active.

Yes, and the rules differ. With an HSA there is no deadline: you can reimburse yourself at any time, as long as the expense came after you opened the HSA and has not been reimbursed or deducted elsewhere. With an FSA the expense must fall within the plan year (plus any grace period), and the claim must be filed within your plan’s deadline.

Keep a receipt for the expense and the LMN. That combination is typically sufficient for an audit.

FSA: “Use it or lose it” each calendar year (some plans allow a small carryover or grace period). You typically submit claims for reimbursement.

HSA: No use-it-or-lose-it. Funds roll over and are yours, even if your insurance changes. HSAs are triple tax-advantaged:

1. Pre-tax contributions
2. Tax-free growth on investments
3. Tax-free withdrawals for qualified medical expenses

To contribute to an HSA you must be enrolled in a qualified high-deductible health plan. Once contributed, the funds remain yours.

No video visit needed. You complete the process by secure message with a provider. No appointments and no waiting rooms.

Sometimes. Per IRS guidance listed in References, gym memberships can be a medical expense only if the membership is purchased solely to affect a structure or function of the body (for example, a prescribed physical therapy plan), or to treat a specific, physician-diagnosed disease (for example, obesity, hypertension or heart disease). If it’s for general health, it’s not a medical expense even with an LMN. Your LMN should tie the membership to your diagnosis and treatment plan (frequency and duration).

Most FSAs ask for:

• A valid LMN from your treating provider (diagnosis, medical necessity, frequency and duration).
• An itemized receipt or monthly statement from the gym.

Many members report full reimbursement when both are provided, but plans vary.

It depends on your plan rules and the medical rationale. Some plans may approve multiple facilities only if your provider documents why both are medically necessary (for example, different modalities tied to your condition). Check your plan’s policy.

We issue LMNs from your treating, US-licensed provider on official letterhead with all required elements (diagnosis, ICD-10 when applicable, specific treatment, frequency and duration, medical-necessity statement, timeframe, NPI, signature and date). Plans may reject generic “health guidance” letters that explicitly state they’re not medical care or don’t create a provider-patient relationship. Our letters are part of an actual clinical encounter and meet typical FSA documentation standards. (Final approval always rests with your plan.)

You typically have two options (your HSA custodian may support both):

1. Pay with your HSA debit card. Use it at pharmacies, clinics, and other health providers. For “dual-use” items (like gyms), the card may decline.
2. Pay out of pocket, then reimburse yourself. Submit your receipt (and LMN if required) to your HSA administrator. Once approved, they’ll transfer funds to your designated bank account.

Tip: HSAs generally don’t pre-approve expenses. Keep your LMN and receipts with your tax records for audit purposes (FSAs usually require documents at the time of claim).

An HSA is a tax-advantaged account you fund with pre-tax dollars to pay qualified medical expenses. Contributions lower taxable income; growth and qualified withdrawals are tax-free.

You must be covered by a High-Deductible Health Plan (HDHP), have no other disqualifying health coverage (such as a general-purpose FSA), not be enrolled in Medicare, and not be claimed as a dependent on someone else’s tax return.

• Minimum deductible: $1,700 (self-only) / $3,400 (family)
• Out-of-pocket max: ≤ $8,500 (self-only) / ≤ $17,000 (family)
• Generally, only preventive care can be covered before you meet the deductible. Exceptions include certain chronic-condition items, such as insulin, and telehealth.

If eligible, open one through providers like Lively, HealthEquity, Fidelity or Bank of America. If your employer offers a Flexible Spending Account (FSA), ask HR. FSAs are different but also use pre-tax funds.

Copays, prescriptions, vision and dental care, plus many others such as: COVID-19 prevention items, OTC meds, addiction services, mobility aids, fertility and reproductive care, cancer wigs and breast reconstruction, acupuncture and chiropractic, medically necessary home modifications, weight-loss programs for medical conditions, standing desks, travel for medical care, and mental health visits.

Most of these qualify on their own. Home modifications, weight-loss programs and standing desks need a Letter of Medical Necessity.

Use your HSA debit card at eligible providers, or pay out of pocket and submit receipts to your HSA administrator for reimbursement.

No. It supports eligibility, but your HSA administrator makes the final call. Keep your LMN and receipts.

We’ll refund you if we didn’t deliver the service. For example, if your request was cancelled, you were charged twice, or a technical issue prevented completion.

If a licensed provider reviewed your case and provided the Letter of Medical Necessity, the fee is non-refundable. No fee is charged for the provider to review. Completing the Letter of Medical Necessity is the medical service you’re paying for.