Why You Should Think Twice Before Asking Your PCP for a Letter of Medical Necessity

Written by Chris Caffrey, ACNP, PMHNP

January 21st 2025

Most people don’t even realize they need a letter of medical necessity—until they’re suddenly confronted with a situation where one is required. Maybe it’s for a health-related item you’re trying to purchase with your FSA/HSA, or perhaps it’s for a treatment that needs insurance approval. Either way, the instinct is to turn to your Primary Care Provider (PCP) for help. But before you ask your PCP for this kind of letter, take a step back. There are plenty of reasons why you might want to think twice, and some better alternatives that could save you both time and hassle.

The Pitfalls of Asking Your PCP for a Letter of Medical Necessity

1. They Likely Don’t Know What They’re Doing

Many medical professionals, including your PCP, aren’t familiar with the specifics of what a letter of medical necessity needs to contain. These letters require certain details, like the diagnosis, how the item addresses that diagnosis, and why it's essential. This might seem basic, but for a lot of healthcare providers, it’s outside their typical scope of work.

In fact, most PCPs have never even written one of these letters. They’re trained to treat medical conditions and prescribe treatments, but writing letters for insurance or FSA/HSA purposes isn’t usually part of their job description. So, they’re left to scramble and figure it out on the fly—which, as you might imagine, could lead to mistakes.

2. There’s No Guarantee They’ll Get It Right

You may think that your PCP, with their years of medical expertise, can knock out a letter of medical necessity with ease. Unfortunately, that’s rarely the case. It’s not just about throwing some medical jargon onto a page. The letter has to be perfect—down to the last detail. If the specifics aren’t exactly right, your claim could be denied. The worst part? Even small errors can cause major headaches down the line.

But here’s the kicker: mistakes in the letter aren’t just inconvenient for you. They’re a hassle for your PCP, too. If the letter gets rejected because of errors, your PCP will likely have to revise it—another time-consuming task that wasn’t reimbursed in the first place.

3. PCPs Have No Incentive to Write the Letter (And It Costs Them Time)

Here’s the truth: when you ask your PCP for a letter, they’re doing it out of the goodness of their heart. Writing a letter of medical necessity isn’t a part of their regular duties, and it’s not something they get paid for. There’s no incentive for them to drop everything and put together a well-crafted letter for your FSA/HSA claim.

Moreover, your PCP isn’t just spending a few minutes jotting down a note. They need to take the time to understand the requirements, write the letter, and possibly revise it if it’s not perfect. All of this comes out of their already packed schedule, and none of it is reimbursed. For a busy healthcare provider, this can feel like an unnecessary burden.

4. The More People Ask, The More Overwhelmed PCPs Become

Let’s say you’re not the only one asking for a letter. As more patients begin to request these letters, your PCP will find themselves inundated with paperwork that isn’t part of their regular workload. This added pressure can cause delays, mistakes, and a general sense of frustration on both ends. It also means less time spent on actual patient care, which is the whole point of seeing a healthcare provider in the first place.

And let’s not forget: if the letters pile up and the quality drops, the risk of denial increases. Your PCP might not be able to give each letter the attention it requires, making your claim more likely to get rejected—and that’s something neither you nor your provider wants.

The Better Solution: FlexUp Wellness PLLC

Instead of burdening your PCP, consider using a service like FlexUp Wellness PLLC. This telehealth company specializes in evaluating individuals to determine eligibility for non-eligible health-related items that can be covered by FSA/HSA plans.

Why choose FlexUp Wellness?

1. We Know the Details: We’re well-versed in the specifics that need to be included in a letter of medical necessity. Our team knows exactly what the letter requires to ensure that it meets all of the criteria for FSA/HSA reimbursement.

   
   

2. No Time Wasted: By working with FlexUp Wellness, you don’t need to worry about your PCP’s time or expertise. We’ll handle everything—from evaluating your eligibility to drafting a thorough, accurate letter of medical necessity.

   
   

3. Helping Your PCP, Not Harming Them: By outsourcing this task to a specialized service, you’re not overwhelming your PCP with additional paperwork. We handle it all, freeing them up to focus on providing direct medical care to their patients.

   
   

4. Expanding Nationwide: Currently serving Massachusetts residents, FlexUp Wellness plans to expand to other states soon. So if you’re in Massachusetts and you need help getting a health-related item covered by your FSA/HSA, FlexUp Wellness is here to support you.

   
   

Conclusion: Don’t Waste Time—Let FlexUp Wellness Handle It

While it may seem like the easy option to ask your PCP for a letter of medical necessity, there are far too many pitfalls to make it the best choice. Instead, let FlexUp Wellness handle the details, so you don’t have to worry about your PCP getting overwhelmed or making mistakes. By working with a company that specializes in these letters, you’ll save time, reduce stress, and ensure your claim is submitted correctly the first time.

Don’t let a letter derail your FSA/HSA reimbursement process. Let us do the heavy lifting for you.

Currently available for Massachusetts residents only, soon to expand to other states.