Physician Practice · multiple states
Care for someone who can't
manage on their own
is medical care.
When a person is chronically ill — unable to perform two everyday activities without help for 90 days or more, or needing constant supervision for their safety — their personal and maintenance care is already medical care under IRS §213(d), by way of §7702B(c). A physician certifies that and prescribes the plan of care it follows from. We don't turn wellness spending into a medical expense — and when the standard isn't met, we say so.
Issued only when the standard is met. If it isn't, you hear it.
See how the letter works →A letter documents care that already qualifies — it cannot make a personal expense medical. Eligibility depends on the diagnosis, the plan of care, and your plan's rules.
Medical Director, DO
practicing hospitalist physician · multi-state licensure · co-op.care co-founder
Altru.care in 15 seconds
- When someone can’t manage alone Help with two daily activities for 90+ days, or constant supervision.
- Three questions, thirty seconds. A quick gut-check, not a clinical determination.
- Then send a short request. Your name, your email, and what the letter is for.
- A physician signs, or declines. Issued only when the standard is met. If not, you hear it.
- Altru.care. A signature only when the standard is met. altru.care
How LMNs work
Three steps from intake to signed letter.
Submit your intake
A few minutes online. Describe the care you are paying for and why the person needs it. This is a request, not an appointment.
Start the intake ↓A physician reviews and signs
Sage AI prepares a draft from your intake. Under the standard, a licensed physician reviews the case and signs or declines. Nothing is issued without that signature.
See how physicians review →Letter delivered
If the physician signs, you receive the signed letter by email. If the standard isn’t met, you hear that instead. Your HSA/FSA administrator makes the final call on reimbursement.
Every signature, hash-anchored →Need ongoing care, not just a letter? co-op.care is forming a worker-owned care cooperative; paid care begins once it is licensed and staffed →
Clinical services
Altru.care is a physician-owned practice. co-op.care is a separate, worker-owned care cooperative its medical director co-founded. Only the letter request is open today; the other services listed here are not yet offered.
Open for requests
Letter of Medical Necessity
Documents care that already qualifies as medical, for a person who can’t manage on their own. A licensed physician signs or declines. A letter cannot make a personal expense medical.
Not yet offered
Chronic Care Management
Planned: ongoing physician oversight for Medicare patients with two or more chronic conditions, with monthly care coordination and medication reconciliation. Not available yet; this practice is not billing Medicare for it today.
Not yet offered with a physician
Advance Care Planning
Planned: a physician-supported conversation that turns your values and preferences into instructions your family and care team can follow. You can begin the conversation yourself today on CareGoals.
Not yet offered
Remote Patient Monitoring
Planned: vitals, activity and weight collected between visits and reviewed by a physician. Not available yet; no monitoring program is running.
Not yet offered
Principal Care Management
Planned: for a person with one high-complexity chronic condition, monthly care plans and specialist coordination. Not available yet; this practice is not billing Medicare for it today.
Is telehealth right for this?
What telehealth can — and can’t — do.
Pick what you need. We’ll tell you honestly whether a remote physician practice is the right fit, what is open today, and where you’d be better served in person.
Why Altru.care
Altru.care vs. telehealth vs. concierge
| Feature | Altru.care | Standard Telehealth | Concierge Practice |
|---|---|---|---|
| Can sign LMNs in your state | Confirmed at intake | Depends on state | Local only |
| AI-drafted, physician-decided outputs | Physician signs or declines | No | Rarely |
| Chronic Care Management (CPT 99490) | Not yet offered | Varies | Rarely |
| LMN for HSA/FSA eligibility | Requests open | Rarely offered | Sometimes |
| Advance care planning (CPT 99497) | Not yet offered | No | Sometimes |
| Ongoing clinical relationship | Not yet: letter requests only | No | Yes |
Medicare code reference
Reference: the Medicare codes and what each requires.
Shown for reference only. Altru.care is not billing Medicare for any of these services today.
| Service | CPT Codes | Key requirement |
|---|---|---|
| Chronic Care Management — non-complex | 99490 | 2+ chronic conditions ≥12 months; 20 min care coordination/month |
| CCM — additional 20 min | 99439 | Add-on to 99490; each additional 20 min documented |
| Advance Care Planning — first 30 min | 99497 | Face-to-face with patient or family; 16+ min minimum; any frequency |
| ACP — each additional 30 min | 99498 | Add-on to 99497; same encounter |
| Principal Care Management | 99424–99427 | Single high-complexity chronic condition; 30 min care plan/month |
| Remote Patient Monitoring — management | 99457, 99458 | 20 min/month; must include synchronous communication (device supply codes bill separately) |
Sources: Signal Lamp Health CCM Rates 2025 · PayerPrice 99497 Fee Schedule · CMS MPFS 2025. Geography and setting affect actual payment.
Before you request one
Will my expense likely qualify?
Three questions, thirty seconds. An LMN needs a genuine medical basis — if yours is missing one, we’d rather tell you now than waste your time.
Is the expense for someone with a real medical need — a diagnosed condition, a recovery, or something like memory decline that makes daily life unsafe?
Would the expense directly help treat or manage that need — home care or companion care hours, or medical equipment?
Honestly — would you be making this purchase anyway, even if the health issue didn’t exist?
A quick gut-check, not a clinical determination. A licensed physician decides whether to sign; nothing is issued without that decision.
Request an LMN assessment
Practitioner evaluation · documented plan of care
Common questions
Will my HSA or FSA accept this letter? ∨
An LMN signed by a licensed physician in your state is the standard documentation required by HSA and FSA administrators. Eligibility depends on your specific plan and the nature of the expense. Home care that qualifies under IRS §213(d) can be paid through an HSA or FSA once an LMN documents the need — see how ComfortCard tracks HSA/FSA savings →. A licensed physician decides whether to sign; nothing is issued without that signature.
Can you issue letters in my state? ∨
Our medical director is licensed in multiple states and practices as a hospitalist. We confirm your state at intake and tell you plainly if we can’t serve it yet. He is also a co-founder of co-op.care — read the founding story →.
Is there a charge? ∨
Nothing is charged or sold on this page, and no payment is collected here. If that changes, the terms will be shown before anyone pays.
What is remote monitoring? ∨
Remote monitoring means devices that send vitals or weight to a clinician between visits. It is not offered here yet; no monitoring program is running.
What is Chronic Care Management (CCM)? ∨
CCM is a Medicare program for patients with two or more chronic conditions: monthly care coordination and medication reconciliation. This practice does not offer it yet. If you are looking for age-in-place tools in the meantime, see careho.me →.
What is Advance Care Planning (ACP)? ∨
ACP is a structured conversation that documents your healthcare wishes: values, preferences, and instructions for your care team and family. A physician-led session is not offered here yet; you can start the conversation yourself on CareGoals →.