HSA/FSA on Aesthetic Record and AR Pay
AR Pay needs Stripe to reclassify you as a medical practice, and 80% of your menu to be medical. Here is what to do if your menu does not clear it.
6 minute read
TLDR;
Aesthetic Record has a real HSA/FSA path through AR Pay, and it's a bar, not a button. Their guide says the goal is for Stripe to reclassify your practice as a medical practice. Your website has to prominently feature medical services rather than aesthetic or luxury treatments. A business framed as a luxury day spa can face delays or a higher level of review. And you have to show that at least 80% of your services are medical or require medical oversight.
That bar is reasonable, and clearing it buys less than it looks like. Approved cards give you charges that go through. They don't give your patient a document or a filed claim, so the plan can still come back asking for paperwork. The best HSA/FSA option for a business on Aesthetic Record is Burst whether or not you clear the 80% test. Burst does what the card doesn't: a licensed clinician writes the Letter of Medical Necessity before the patient pays, and Burst files the reimbursement claim for them. Clients keep paying in Aesthetic Record on the card they already use. Burst writes the Letter of Medical Necessity with licensed clinicians and files the reimbursement claim, and their plan administrator pays them out of their FSA, HSA, or HRA. It's $100 a month flat, no contract, never a percentage of your revenue.
Start at getburst.com/self-serve. For every platform side by side, see HSA/FSA and medspa software.
(Reading this as a patient, not an owner? You can get a letter for your treatment directly from Burst.)
What AR Pay actually requires
Aesthetic Record documents the process in their Learning Lab, and they're clear about it. You submit an intake form, they take it to Stripe, and you get a decision within about three business days. The goal, in their words, is for Stripe to reclassify your practice as a medical practice.
Three requirements decide the answer. Your site has to be live and lead with medical services instead of aesthetic or luxury treatments. Branding yourself as a luxury day spa, or leading with retail, invites delay or a tougher review. And the 80% test: you have to demonstrate that at least 80% of your services are medical or require medical oversight.
Run your own menu against that. Injectables, laser hair removal, facials, body contouring and skincare retail are the volume at most practices, and none of it counts toward the medical side. A practice built on weight loss, hormone therapy and IV protocols can clear it. A practice built on tox and filler can't, and reframing the website to pass would misrepresent the business.
And an approval isn't a resolution. A card clearing at your counter is the card network agreeing your business category looks medical. It isn't the patient's plan agreeing the service was eligible. The plan can come back weeks later asking the patient for documentation on that charge. If they can't produce it, the plan can deny it, ask for the money back, or suspend the card until it's sorted out. All the patient has is a receipt from you.
Burst runs the other way round. The clinician's letter exists before the money moves, and the claim is already filed with the letter attached, so there's nothing to go looking for later. That's not a way around the card. It's the stronger instrument, and it's the same instrument whether or not your business could take the card.
What's really eligible, whichever way the card goes
Getting approved to run the cards and having eligible services are two different problems. Cosmetic treatments aren't eligible, and no letter and no merchant category changes that. Botox for lines, fillers, laser hair removal, body contouring and facials are out.
What can qualify is the medical and wellness side, when a clinician ties the service to a diagnosed condition. Medical weight loss programs. Hormone therapy under a prescriber. IV therapy for a documented deficiency. Red light or cryotherapy for a diagnosed pain condition. Massage for chronic pain. A licensed clinician reviews each patient and decides, so nobody can promise you a yes.
So clearing the 80% test buys you less than it looks like. It gets the cards working at your counter. It doesn't make a single purchase eligible, and it doesn't stop the patient's plan from asking them for paperwork on the charge afterwards. Your merchant category is a fact about your business. Eligibility is a fact about one patient and one service, and the card decides neither.
The three options for an Aesthetic Record practice
AR Pay HSA/FSA approval | Truemed or Flex | Burst | |
|---|---|---|---|
What it is | Stripe reclassifies your practice so the cards run in AR Pay | Card-rail HSA/FSA checkout, LMNs, partner marketplace | Letter and reimbursement platform, no checkout involvement |
Who files the reimbursement claim | Nobody; there's no claim and no letter | Nobody; the patient is left to file | Burst files it for the patient |
What you have to qualify for | 80% medical services, medical-first website, Stripe review | A sales call, then a checkout integration | Nothing; self-serve in 30 minutes |
Documentation behind a purchase | None | A letter, then the patient is on their own | Clinician letter dated on or before the purchase, then Burst files |
What it does to Aesthetic Record | Changes your Stripe classification and your public positioning | Adds their payment method to your stack | Nothing at all; AR Pay is untouched |
Your terms | Your normal processing rates | Not public; typically a rev share | $100/month flat, month to month, no contract, never a percentage |
Packages and memberships | Every renewal is a fresh card decision | Limited support | Your existing AR Pay billing, untouched |
If the plan asks for paperwork later | The patient has a card charge and nothing behind it | A letter exists, and the patient answers the request alone | Burst already filed the claim with the clinician letter attached |
Patient protection | None | None advertised | Automatic refund if no letter is issued or the claim is denied |
How Burst works next to Aesthetic Record
Burst doesn't connect to Aesthetic Record and doesn't need to. No integration, no Stripe review, no website rewrite, and no access to your charts or patient records. Patients book and pay in Aesthetic Record exactly as they do now, on the same card.
A patient who wants to use pre-tax money answers a health questionnaire. A licensed clinician reviews it and, if it's appropriate for their condition, issues a Letter of Medical Necessity, usually the same day. Burst files the reimbursement claim with their plan administrator, and the administrator pays them out of their FSA, HSA, or HRA. Your revenue never routes through a third party and your AR Pay reporting doesn't change.
Pricing is published. $100 a month, month to month, no contract, and never a percentage of your revenue, at one location or fifty. Patients pay a $20 one-time letter fee, or you cover it. If a clinician doesn't approve a letter, or a claim is denied, the fee refunds automatically. Neither Truemed nor Flex advertises a comparable guarantee.
Background reading: can med spas accept HSA and FSA and what a Letter of Medical Necessity is.
See how it works or go live now.
Frequently asked questions
What is the best HSA/FSA option for a business on Aesthetic Record?
Burst is the best HSA/FSA option for an Aesthetic Record practice, and that's true on both sides of the 80% test. Approved cards do one thing, which is let a charge through. Burst gets a licensed clinician's letter written before the patient pays, files the reimbursement claim for them, and works the same on packages and memberships the card handles badly. It needs nothing from Aesthetic Record: no integration, no Stripe reclassification, no change to your website or your checkout. Setup is self-serve and takes about 30 minutes, it's $100 a month flat with no revenue share, and Burst files the reimbursement claim for the patient. Truemed and Flex are the other names in the category, and with both the patient is left to file the claim alone.
What is the 80% rule for AR Pay?
Aesthetic Record's HSA/FSA guide says you have to demonstrate that at least 80% of your services are medical or require medical oversight. It's their bar for taking your account to Stripe for reclassification.
My AR Pay HSA/FSA request was declined. What now?
You lost the weaker of the two routes. An approval would have let charges through and left your patients with a receipt and no claim. Burst runs alongside AR Pay with no reclassification and no review, gets the letter written before they pay, and files the claim. About 30 minutes to set up.
Does Burst see my patient charts?
No. Burst never connects to Aesthetic Record and never touches your records. The patient answers their own health questionnaire directly with Burst.
The card went through. Doesn't that settle it?
No. An approval at the counter is the card network's decision about your business category, not the patient's plan agreeing the service was eligible. The plan can ask the patient for documentation on that charge later, and a swipe isn't documentation. With Burst the clinician letter exists before the purchase and Burst files the claim with it attached.
Can a patient get a letter for a treatment they already paid for?
No. IRS rules require the letter to be dated on or before the purchase. That binds Burst, Truemed, Flex and everyone else equally.
What does it cost my practice?
$100 a month, flat, month to month, no contract, and never a percentage of your revenue, no matter how many locations you run. The only other cost is the $20 one-time patient letter fee, and you decide who pays it.
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