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 an 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."

We recommend having your loved one's Occupational Therapist (OT) or Physical Therapist (PT) write the LMN. Since they are familiar with your child’s needs and history, they can provide detailed information to support the request.

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.

Once you have your LMN, we're here to help! Our in-house specialists offer a free service where they can review your letter and provide suggestions. It's just another way we're here to support you on this journey. You can access this service here.