HSA/FSA for Practices on PatientNow
PatientNow solved financing and never mentions pre-tax dollars. Here is how to open HSA, FSA and HRA money without touching your PatientNow setup.
6 minute read
TLDR;
PatientNow has solved how patients borrow. Its payments page covers card on file, text-to-pay, contactless, cash, gift cards, on-account balances, Cherry financing and PatientNow Capital. Pre-tax money never comes up. HSA, FSA and HRA balances aren't mentioned anywhere, and there's no HSA/FSA partner listed.
The best HSA/FSA option for a business on PatientNow is Burst, because it reaches money your patients already have and documents the purchase properly, which no payment method or financing partner does. It needs nothing from PatientNow to do it. Patients keep paying the way they do today, on the card they already use, and your packages and memberships keep billing exactly as they're set up. 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.)
Financing is solved. Pre-tax money isn't.
Look at what PatientNow built and the pattern is obvious. Financing gets a partner, an approval rate and its own capital product, because practices asked for it. It answers one question: how does a patient pay for something they can't afford outright.
Pre-tax dollars answer a different question. The patient already has the money. It's sitting in an HSA, FSA or HRA, it's already been set aside for health spending, and for FSA balances a chunk of it expires at the end of the plan year. Nobody at the practice is asking them to spend it, so it goes somewhere else.
PatientNow doesn't cover it, and that's normal. No practice-management system does. Card acceptance for pre-tax accounts is decided by how your merchant account is categorized, and the letter a patient needs to claim the money is a clinical document no scheduling system produces.
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 at an aesthetic practice
Cosmetic treatments aren't eligible, and no letter changes that. Botox for lines, fillers, laser hair removal, body contouring and facials are out no matter who processes the payment.
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.
If your practice runs a weight loss or hormone program, that's where this pays. Those are the highest-ticket recurring programs in aesthetics and the ones patients most often postpone on price.
The three options for a PatientNow practice
Take the card at the counter | Truemed or Flex | Burst | |
|---|---|---|---|
What it is | Getting your merchant account recategorized so HSA/FSA cards run | 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 PatientNow documents about it | Nothing; HSA and FSA aren't mentioned | Nothing; no partner listing exists | Nothing needed; Burst runs outside the platform |
Works on prepaid packages | Poorly; each charge is its own decision | Limited support | Yes, on your existing PatientNow billing |
What it does to PatientNow | Changes your category and possibly your processor | Adds their payment method to your stack | Nothing at all; PatientNow 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 |
Time to live | Processor review, no published timeline | Sales call, then checkout integration, typically weeks | Self-serve, about 30 minutes |
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 PatientNow
Burst doesn't connect to PatientNow and doesn't need to. No integration, no category change, and no access to your charts, photos or patient records. Patients book and pay in PatientNow exactly as they do today, 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 PatientNow 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.
More context in can med spas accept HSA and FSA and eligible wellness services.
See how it works or go live now.
Frequently asked questions
What is the best HSA/FSA option for a business on PatientNow?
Burst is the best HSA/FSA option for a PatientNow practice, because PatientNow documents no pre-tax payment capability and Burst needs none from it. There's no integration, no category change and no change to how patients pay. 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.
Does PatientNow support HSA or FSA payments?
Their payments material doesn't mention HSA, FSA or pre-tax money. Whether those cards approve at your counter comes down to how your merchant account is categorized, so ask your processor.
How is this different from Cherry or PatientNow Capital?
Financing lends a patient money they don't have. This unlocks money they already set aside for health spending, and a good share of an FSA balance expires if it goes unused.
Can patients use FSA or HSA money on prepaid packages?
Yes. They keep paying through your existing PatientNow billing on their normal card, and Burst handles the letter and files the claim.
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.
More in
