Letter of Medical Necessity
You may receive an Explanation of Unpaid Expenses (EOUE) or an Explanation of Payment (EOP) Denial telling you 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. A Letter of Medical Necessity is written by your licensed medical practitioner (MD, PA, DO, DC, etc.) and 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.
The LOMN is valid for up to one year or the completion of the treatment, whichever is sooner. You only need to submit the LOMN for a treatment with the first related reimbursement request each year.
If you receive an EOUE or EOP Denial indicating that an LOMN is needed, do the following:
Contact your licensed practitioner and request an LOMN. They can write a letter, no form is required.
Submit the LOMN with a copy of the EOUE or EOP to Via Benefits for reprocessing.
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 on the provider’s official letterhead, prescription pad, or discharge papers.
If you need more assistance in requesting the LOMN, please contact us.
*Via Benefits reimbursement accounts are administered by Extend Health, LLC.