HSA/FSA

HSA/FSA Accepted

Please confirm any specific requirements for individual eligibility and reimbursement of your purchase with your benefits coordinator or your tax professional. See our FAQs for more information.

If your plan requires a letter of medical necessity from your physician, you can find a template below.

Letter of Medical Necessity Template

Date:

To Whom It May Concern:

I am writing on behalf of my patient to document the medical necessity of completing educational courses regarding the diagnosis of:

• Infertility - Female Factor
• Infertility - Male Factor
• PCOS
• Endometriosis
• Miscarriage/Pregnancy Loss
• Other: __________

This patient has faced difficulty conceiving or carrying a pregnancy to term. After completing an evaluation, I have recommended that the patient consider various treatment options available.

Infertility is a complex medical condition and requires significant knowledge to manage. Taking fertility education courses directly related to the condition will be beneficial to the patient in navigating the diagnosis and making informed decisions about the treatment plan.

The patient should begin taking relevant classes, if that is their preference, from now until the condition has been resolved or until they no longer consider classes useful.

Please call my office if you require any additional information or documentation.

Sincerely,

Doctor Name:

Office Phone:

Patient Name:

Patient DOB: