What is a Letter of Medical Necessity (LMN)?

A Letter of Medical Necessity (LMN) is a critical document written and signed by your physician or therapist that focuses on safety concerns and outlines the patient’s medical condition, the necessity of the requested equipment or treatment, and how it will improve the patient's health.

Why do you need an LMN?

An LMN provides detailed explanations of why specific medical equipment or treatments are essential for a patient's well-being. This helps to establish the medical need and supports the approval of insurance claims. By documenting the medical necessity of a product, they can demonstrate that healthcare decisions were made in the best interest of the patient.

Best practices when writing your LMN:

Emphasize safety concerns that can result in increased costs for the insurance company. They often prefer investing in expensive equipment to prevent hospital visits or other safety-related expenses. If possible, provide quantifiable data by referencing past bills for such safety risks.

Avoid speculative scenarios like, "She may engage in self-injurious behavior if…" Instead, use concise and firm statements like, "She engages in self-injurious behavior leading to blunt force trauma to her head."

Medical conditions and diagnosis

Describe the patient's medical condition, diagnosis, and any underlying conditions or relevant medical history. Be specific and provide supporting medical documentation or test results.

Description of equipment

Explain in detail the medical equipment that is being requested. Include the name and model number (Cubby Basic or Cubby Plus), and any specific features that make it essential for the patient's well-being. 

Rational for medical necessity

Clearly state why the Cubby Bed is medically necessary for the patient. Be sure to align the unique features of the Cubby Bed with the medical need it will address (see our Justification Guides above). Discuss how it will improve the patient's health, quality of life, and safety. Reference relevant medical guidelines or recommendations if applicable.

Alternatives considered

Mention any alternative treatments or equipment that have been used or considered and why they are not suitable or effective for the patient's condition. If applicable, also include other ways you have been unsuccessful in solving issues.

Supporting documentation

Attach copies of medical records, test results, or other supporting documentation that corroborate the medical necessity. This should include documented safety concerns from the patient's doctor or therapist. Reference these attachments in the letter.

A Letter of Medical Necessity (LMN) focuses on safety concerns and outlines the patient’s medical condition, the necessity of the requested equipment or treatment, and how it will improve the patient's health.

The link below explains what a LMN is, why you need it, and how to write it.

Understanding + Writing a LMN

Sure! This is an example of a high quality LMN. Please use this LMN Example as inspiration for how your doctor fills out the LMN Outline (linked above) when drafting your own letter.

LMN Example

We recommend that the prescribing doctor writes the LMN or you can have a supporting therapist such as an Occupational or Physical therapist write it. The LMN should include past patient history.

LMNs can be a complex but important piece of documentation. Using our outline linked above, it should take you ~20 minutes. Much faster than starting from scratch so make sure to download it :)

Yes! We're here to support you. Contact our Cubby Care Team with any questions or to review your LMN.