Medical Necessity Letters
Insurance companies often require a letter of medical necessity before approving coverage for treatments, equipment, or procedures. Our licensed clinicians provide thorough, professionally written letters to support your claim.
What it is
A letter of medical necessity (LMN) is a document from a licensed healthcare provider that explains why a specific treatment, medication, medical equipment, or procedure is medically necessary for a patient's condition. Insurance companies — including private insurers, Medicare, and Medicaid — use these letters to determine whether a service meets their coverage criteria. Without a properly written LMN, insurers may deny coverage for treatments that are clinically appropriate for your condition.
Why you may need it
Insurance denials for medically necessary care are common. A well-written letter of medical necessity that clearly documents your diagnosis, the treatment requested, why alternatives are insufficient, and the clinical evidence supporting the request can be the difference between approval and denial. Our clinicians understand what insurers look for and can write letters that address the specific criteria your insurer uses.
Conditions we commonly evaluate
- Durable medical equipment (wheelchairs, CPAP, braces)
- Specialty medications or biologics
- Physical or occupational therapy
- Mental health treatment
- Bariatric surgery
- Reconstructive surgery
- Home health services
- Specialized diagnostic testing
- Out-of-network provider access
- Experimental or off-label treatments
- Nutritional supplements or medical foods
- Chiropractic or alternative therapies
- Continuous glucose monitors
- Genetic testing
Fast, accurate documentation — 100% telehealth
Our clinicians review your medical history and the specific treatment or equipment being requested, then write a comprehensive letter of medical necessity that includes your diagnosis (with ICD-10 codes), the clinical rationale for the requested service, why standard alternatives are inadequate, and supporting clinical evidence. The letter is formatted to meet insurer requirements and delivered digitally.
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Medicare and Medicaid requirements
Medicare and Medicaid have specific medical necessity standards defined in the Social Security Act and CMS coverage policies. For Medicare, a service is considered medically necessary if it is reasonable and necessary for the diagnosis or treatment of illness or injury. Documentation must support the medical necessity of the service billed. Our clinicians are familiar with CMS documentation requirements. (Source: CMS, cms.gov)
Using an LMN in an insurance appeal
If your insurer has already denied a claim, a letter of medical necessity is a critical component of the appeals process. Under the Affordable Care Act, you have the right to appeal insurance denials. A strong LMN that directly addresses the insurer's denial rationale significantly improves the likelihood of a successful appeal. Our clinicians can write letters specifically tailored to support an appeal.
Information on this page references CMS coverage policies (cms.gov), the Social Security Act (42 U.S.C. § 1395y), and ACA appeals rights (healthcare.gov). This page is for informational purposes only and does not constitute legal or financial advice.
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