FSA & HSA
Letters Of Medical Necessity
If your FSA or HSA administrator wants documentation before they'll cover your treatment, your provider can write you a letter. The request takes about a minute.
Request Your LetterWhat You'll Be Asked For
A Letter of Medical Necessity is a short note from your provider explaining why your treatment is medically necessary — it's what a plan administrator usually wants before approving an FSA or HSA expense. Have these four things handy and the form goes quickly.
Your Name And Date Of Birth
Exactly as they appear on your account, so your provider can match the request to your chart.
The Email To Send It To
Your finished letter is emailed to the address you give on the form, so double-check it before you submit.
What You Need Covered
The specific medication or service your plan is asking about. If your administrator named it in their request, use their wording.
Your Provider And Visit Date
The provider from your most recent consultation, and the date of that visit.
Not sure who your provider was? Check who sent your last consult message in the patient portal. If you still can't tell, email our support team and we'll look it up for you.
How It Works
Three steps, and only the first one needs anything from you.
Step 01
You Submit The Request
Fill out the request form with the details above. Submitting it is also how you consent to receiving the letter by email.
Step 02
Your Provider Prepares It
The provider who saw you reviews your request and writes the letter based on your treatment and your chart.
Step 03
It's Emailed To You
You'll get a copy at the address you provided. From there you submit it to your plan administrator yourself.
We can write the letter, but we can't approve the expense. Whether your plan accepts it is your administrator's decision, and eligibility rules differ from plan to plan. If they turn it down or want something worded differently, let us know what they're asking for and we'll do what we can.
Nothing here is tax advice — for questions about what your account allows, your plan administrator is the right place to ask.
If your administrator has their own form, email our support team rather than using the request form — there's no place on it to attach a document, so we'll handle that one by hand.
If You Need Something Else Instead
A letter isn't always what a plan is after — sometimes they just want proof of what you paid for.
Looking for a receipt, an itemized statement, or a record of what you've been prescribed? Those come from a document request rather than this form.
Trying to pay with an FSA or HSA card and it's being declined? Some plans only accept cards at merchants they've categorized as eligible.
Ready When You Are
Submit your request and your provider will take it from there. If anything about your plan's requirements is unclear, email our support team first — it's easier to get the letter right the first time than to redo it.
Request Your LetterQuestions about this request are handled by our support team at support@lavenderskyhealth.com. For anything about your medication, dosing, or symptoms, message your provider in the patient portal instead.