Some of our best days as therapists hinge on the letter of medical necessity (LMN). Those days when our LMNs help deliver the mobility device a client desperately needs, we feel like we own the planet. By contrast on those days when our LMN is denied we become mad enough to spit. Maybe mad enough to go on an adjective-laden tirade. Maybe mad enough to get in our car, back out of the parking lot, and—distracted by our own outrage—push right into a fire hydrant.


Positive emotion is fuel for the engine within us that espouses good works. Positive emotion has the power to carry us to a positive result. Negative emotion can work against us, even if we feel we somehow feel we have a right to feel negatively. We can become distracted by negative emotion and lose our focus. Next thing you know you’ve had a fender bender with fire department property. This is an example of why therapists must not let negative feelings overcome them. Especially at risk of infringing on the good works one might accomplish.

The LMN is a force for good, which is why it is critical to write the best LMNs possible. This is also where we must lock out our egos—leave them on the porch—and consult, collaborate, and investigate with whoever we must to create an LMN that gets the job done. If someone else has expertise about a device or application we lack, we must seek them out. Therapists wage battle after battle with insurance companies, and sometimes it may feel like “It’s war out there!” If that is the case you’ll need backup, and it’s your duty to swallow your pride and ask for that backup. After all, no fighter pilot ever became an ace without the aid of a good wingman.

Language of the LMN is vital, so know your reader. Clinical backup is vital, so know your literature. The person reading your LMN may lack foresight and understanding. Educate that person and be relentless.

I recently ran across an article about an ALS patient who was denied for a Permobil C300 four times before finally getting approved. The good folks at the patient’s insurance company seemed to lack any comprehension about ALS, and how it progresses. With nothing really to lose, the patient and his physician decided to take the insurance company to school, so to speak. And they won.

You can read the full article here:

Every battle we fight to help a client become more independent and engaged is worth fighting. Most times in our own judgment we know a client needs and deserves the device for which we seek funding. We have to act on that judgement—as many times as necessary. It seems to me when we abandon our own judgment we may also in some way abandon ourselves. Allow no one to grind you down. Nothing is over until we decide it is.