## What it is A Letter of Medical Necessity (LMN) is a signed statement from your treating physician that your strict gluten-free diet is prescribed medical treatment, not a lifestyle choice. HSA and FSA administrators use it to confirm that your gluten-free grocery premium and related expenses qualify for reimbursement. ## Download the template Gluten Hero provides a free, ready-to-sign template at [resources.glutenhero.net/lmn-template](https://resources.glutenhero.net/lmn-template/). It includes: - The ICD-10 diagnosis code (K90.0 for celiac disease) - The medical necessity language your administrator is looking for - The specific expense categories covered under IRC Section 213(d) - Signature lines for your provider Download the DOCX if you want to fill in your personal details before printing, or the PDF if you want to hand it to your doctor as-is. ## Getting it signed **Bring it pre-filled.** Fill in your name, date of birth, address, and member ID before the appointment. Leave the medical language and the diagnosis date for your doctor. **Frame it simply.** "I use my HSA for celiac expenses. My administrator requires a Letter of Medical Necessity. I drafted one based on your records. Could you review and sign?" **If they push back**, point them to the Celiac Disease Foundation or Beyond Celiac pages on tax deductions. Both describe the same LMN documentation requirement. **If they cannot sign at the visit**, email or fax the template to the practice's care coordinator and ask them to return a signed copy. A small form fee ($10–$50) is common and almost always worth it. ## Filing it Submit the signed letter through your HSA or FSA administrator's portal or secure upload. Some administrators have their own LMN form — check with yours before submitting to avoid a resubmission. ## Renewal Most administrators require a fresh letter every 12 months. Gluten Hero will remind you when yours is approaching renewal.
Letter of Medical Necessity template
3 min read