Letter of Medical Necessity
This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement)*.
You may receive an Explanation of Unpaid Expenses (EOUE) indicating an expense wasn't approved and that Via Benefits requires a Letter of Medical Necessity (LOMN) to reprocess your reimbursement request. Under IRS rules, you must provide a certification of medical necessity for some products and services. An LOMN is a letter written by your doctor or healthcare provider. It verifies that the services or items you're purchasing are for the diagnosis, treatment, mitigation, or prevention of a disease or medical condition. The letter provides certification that services and products used for both general good health and to treat a medical condition are eligible for reimbursement.
Examples of services needing an LOMN include massage therapy, exercise equipment or programs, gym memberships, vitamins or dietary supplements, and weight loss programs.
The LOMN is valid for up to one year or until the completion of the treatment, whichever is sooner. You'll only need to submit the LOMN with the first reimbursement request each year.
If you receive an EOUE indicating that an LOMN is needed, do the following:
Contact your licensed practitioner and request an LOMN. They will be familiar with this request.
Most practitioners have a form letter they use for an LOMN. Via Benefits doesn't provide an LOMN form.
Submit the LOMN with a copy of the EOUE to Via Benefits for reprocessing. You can mail the document to the address provided at the top of your EOUE or upload it to your account. Select the Resolve option tied to the expense that needs the LOMN.
The LOMN isn't a guarantee that you'll receive reimbursement for the expense.
Information to be included in the letter:
Patient name and identifying information (e.g., DOB, last four (4) of SSN)
Description
The specific diagnosis or treatment needed, including a short description of the recommended service or product (e.g., “Massage therapy recommended twice weekly for six months to alleviate back pain.”)
Signature of a licensed practitioner (e.g., MD, PA, DO, DC) on the provider’s official letterhead, prescription pad, or discharge papers.
Please contact us if you need any assistance requesting the LOMN.
*Via Benefits reimbursement accounts are administered by Extend Health, LLC.