FSA/HSA Letter of Medical Necessity (LMN) Generator

Save 30-40% on Your Cold Plunge with Pre-Tax Dollars

In the United States, you can often purchase a cold plunge unit like the StillPlunge using your FSA (Flexible Spending Account) or HSA (Health Savings Account).

This allows you to use pre-tax money, saving you 30-40% on the purchase. To do this, you almost always need a "Letter of Medical Necessity" (LMN) from your doctor. This tool helps you create a perfectly formatted request letter to give to your doctor.

Step 1: Your Information

Your Full Name

Your Street Address

Your City, State, ZIP

Your Phone Number

Your Email

Step 2: Your Provider's Information

Doctor's Full Name

Doctor's Last Name (for greeting)

Clinic or Practice Name

Clinic's Street Address

Clinic's City, State, ZIP

Step 3: Your Symptoms

Select all that apply (Your doctor will confirm):

Chronic Back Pain Muscle Inflammation & Soreness Arthritis / Joint Pain Anxiety & Stress Reduction Post-Exercise Recovery Fibromyalgia Symptoms

Step 4: Generate Your Letter

Disclaimer: This tool generates a letter request. It is not a medical document or a guarantee of approval. You must present this letter to your medical provider for their professional review and signature.

Or, Copy a Manual Template

Prefer to use your own word processor? Copy the template below and fill it out at your convenience.

[Your Full Name]
[Your Street Address]
[Your City, State, ZIP Code]
[Your Phone Number]
[Your Email]

April 10, 2026
[Doctor's Name]
[Doctor's Clinic or Practice Name]
[Clinic's Street Address]
[Clinic's City, State, ZIP Code]

Subject: Request for Letter of Medical Necessity (LMN) for Cold Water Immersion Unit

Dear Dr. [Doctor's Last Name],

I am writing to request a Letter of Medical Necessity (LMN) for a cold water immersion unit to treat a medical condition you have been helping me manage. As we have discussed, I experience symptoms related to:

- [List Your Symptoms Here, e.g., Chronic Back Pain, Inflammation]
- [Symptom 2]
- [Symptom 3]

After researching all available treatments, I believe that regular cold water immersion therapy (cryotherapy) would be a highly beneficial, non-drug component of my treatment plan.

I am requesting this letter so I may submit a claim for reimbursement using my Flexible Spending Account (FSA) / Health Savings Account (HSA). The purchase of this device is for the direct treatment of my specific medical condition(s).

The specific device I have researched is a Cold Water Immersion Unit (Recommended: StillPlunge). The medical-grade precision temperature control and water filtration of this particular unit are crucial for ensuring safe, consistent, and effective therapeutic use at home.

Could you please provide a letter that includes the following details for my benefits administrator?

1. Your diagnosis (the specific medical condition).
2. A brief description of my symptoms that this device will treat.
3. Your professional recommendation that this cold water immersion unit is medically necessary for my treatment.

Thank you for your time and consideration.

Sincerely,

[Your Full Name]

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FSA/HSA Letter of Medical Necessity (LMN) Generator

Step 1: Your Information

Step 2: Your Provider's Information

Step 3: Your Symptoms

Step 4: Generate Your Letter

Or, Copy a Manual Template

Your Cart

FSA/HSA Letter of Medical Necessity (LMN) Generator

Step 1: Your Information

Step 2: Your Provider's Information

Step 3: Your Symptoms

Step 4: Generate Your Letter

Or, Copy a Manual Template

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Your Cart

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