Products that require an LMN, and how to get one.
Some HSA/FSA-eligible products only qualify for reimbursement with a Letter of Medical Necessity (LMN) from a licensed provider. Here's what requires one, how to obtain it, and how to submit to WellBefore before you buy.
What is a Letter of Medical Necessity?
An LMN is a short note from your doctor (or other licensed healthcare provider) stating that a specific product is being used to treat, alleviate, or prevent a specific medical condition. Your plan administrator needs this documentation on file to approve reimbursement for products in certain "dual-use" categories — items that could be used for either general wellness or medical treatment.
Without an LMN on file, your plan may deny reimbursement even for items listed as HSA/FSA eligible. WellBefore's Eligibility Guarantee does not apply to products that required an LMN and were purchased without one on file.
Product categories that typically require an LMN
The exact list varies by plan, but these are the categories most commonly flagged. When in doubt, confirm with your plan administrator before purchase.
Nutritional supplements & vitamins
Most plans require an LMN unless the supplement is prescribed for a specific deficiency or condition (e.g., prenatal vitamins, iron for anemia, calcium for osteoporosis).
Weight-loss programs and products
Eligible only with an LMN specifying a diagnosed medical condition such as obesity, hypertension, or heart disease. Weight loss for general fitness does not qualify.
Fitness and exercise equipment
Treadmills, exercise bikes, weights, and similar equipment generally require an LMN stating the specific condition being treated.
Massage therapy and related tools
Massage chairs, percussion devices, and therapeutic massage require an LMN identifying the specific medical condition (e.g., chronic back pain, fibromyalgia).
Air purifiers, humidifiers, filters
Require an LMN specifying a respiratory condition such as asthma, COPD, or severe allergies.
Dental & orthodontic — cosmetic vs. medical
Routine oral care (toothbrushes, floss, mouthwash) and cosmetic dental work may require an LMN under some plans. Medically necessary procedures (crowns, fillings, orthodontic correction) generally do not.
Special foods and therapeutic diets
Gluten-free foods (celiac disease), low-sodium foods (hypertension), or other therapeutic diets require an LMN. Only the incremental cost over comparable non-therapeutic foods is reimbursable.
Skincare & acne treatments
OTC acne treatments typically do not require an LMN after the CARES Act of 2020. Prescription-strength or specialty skincare may require one depending on plan.
Not on this list? If you're unsure whether a specific product requires an LMN, ask our support team before you buy, or confirm with your plan administrator. Plans vary.
How to obtain a Letter of Medical Necessity
It's typically a simple document — one page, one signature — but it must come from a licensed healthcare provider who has evaluated you.
Talk to your provider
Ask your doctor, nurse practitioner, physician assistant, dentist, chiropractor, or other licensed provider. Explain the product you want to purchase and the condition it's intended to treat, alleviate, or prevent.
Request the letter
Ask for a signed letter on provider letterhead that includes: (a) your name, (b) the specific medical condition or diagnosis, (c) the specific product or product category being recommended, (d) a brief explanation of how the product treats or alleviates the condition, and (e) the recommended duration (often one year).
Submit to your plan administrator
Upload the LMN through your plan administrator's portal (HSA or FSA provider). Most plans require the LMN on file before the purchase date for reimbursement to be approved.
Keep a copy
Store a digital copy with your tax records. If your plan audits the purchase later, you'll need to produce the LMN on request. LMNs typically remain valid for 12 months and need to be renewed annually for ongoing use.
Submit the LMN to your plan administrator, not to WellBefore
WellBefore does not hold or review LMNs. The LMN goes to your HSA or FSA plan administrator, who uses it to approve or deny reimbursement at the plan level.
LMN-required products & the WellBefore Eligibility Guarantee
Our Eligibility Guarantee protects you when a purchased product is denied by your plan for eligibility reasons. It does not cover denials caused by a missing LMN on a product where one was required.
Before purchasing items in any of the LMN-required categories listed above:
- Confirm with your plan administrator whether an LMN is needed.
- Obtain the LMN from your provider and submit it to your plan before the purchase.
- Keep a digital copy with your tax records.
Taking these three steps turns an LMN-required purchase into a protected one.
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