Best HSA/FSA Option for Telehealth Brands
What a telehealth brand can offer patients, what carries a letter, and how to run HSA/FSA reimbursement on your existing checkout for $100 a month.
7 minute read
Short answer
For a telehealth brand or a direct primary care practice, the best HSA/FSA option in 2026 is Burst. Patients pay through your existing checkout exactly as they do now, and you're live in 30 minutes with nothing to install. It's $100 a month with no contract, plus a $20 one-time letter fee that the patient or you can pay. Burst writes the letter of medical necessity and files the reimbursement claim.
Telehealth is the case where the card route fails hardest. You bill monthly, you often bundle a consult with a product, and you deliver digitally. All three are the conditions a card-rail checkout handles worst.
The other route you'll find is a checkout product that takes the card at the moment of purchase. Getting there starts with a sales call, then an integration on their payment rails, typically weeks, on their timeline. The merchant terms aren't published and typically include a rev share. And at the end of it, when your patient has a letter, nobody files the claim for them. The patient is left to do it alone.
To offer it this week, start at getburst.com/self-serve.
(Reading this as a patient, not a telehealth or DPC practice? You can get a letter for your own care directly from Burst.)
What telehealth care can carry a letter, and what never will
A letter names a condition and explains how the care treats it. In telehealth the line usually falls between care for something diagnosed and care sold as optimization.
What you offer | Can carry a letter | What the letter names |
|---|---|---|
Consults and visits for a diagnosed condition | Usually | The condition being treated |
Chronic condition management programs | Usually | Diabetes, hypertension, a thyroid or metabolic condition |
Mental health care and therapy | Usually | A diagnosed condition under active care |
Medically supervised weight management | Often | Obesity or a metabolic condition, with the clinical plan |
Dermatology for acne, eczema or rosacea | Often | The diagnosed skin condition |
Direct primary care memberships | Sometimes | Depends on the plan; some administrators treat a DPC fee differently |
Longevity, performance and optimization programs | Never will | No condition, so no honest letter |
Cosmetic treatment | Never will | Cosmetic regardless of documentation |
The test is one sentence: would a clinician name the condition and explain how this treats it? Telehealth brands are unusually well placed here, because a clinician is already involved and the diagnosis already exists in the chart.
Why does the HSA card fail at my checkout?
The card declines because the networks only approve HSA and FSA card charges at businesses coded as medical providers, or at retailers that check every item in the cart against an eligibility list in real time, and a telehealth brand is usually neither. Monthly programs make it worse, because every renewal would have to pass that check again. Bundles fail too: a consult plus a prescription plus a device on one charge is a single transaction that either clears or doesn't.
Some practices do get categorized as medical and see cards approve. Worth knowing what that buys: an approval means the network agreed your category looks medical. It isn't the plan agreeing the care was eligible, and the plan can ask your patient for documentation on that charge later.
The three options for a telehealth brand, side by side
Option | Getting live | Cost to you | Monthly programs | Who files the claim | Fits |
|---|---|---|---|---|---|
Take the HSA/FSA card at checkout | Be categorized as a medical merchant, or check every item in the cart in real time | Processor dependent, and unavailable to most digital-first brands | Each renewal rechecked, and bundles fail as one charge | Nobody; there's no claim and no letter | Clinics already billing as providers |
Truemed or Flex | Sales call, then checkout integration, typically weeks | Not public; typically a rev share | Limited support | Nobody; the customer is left to file | Online brands in their partner network |
Burst | Self-serve, live in 30 minutes, no integration | $100/month, month to month, no contract; $20 one-time letter fee per member, paid by the member or by you | Renewals keep running on the card on file; nothing changes | Burst files it for the member | Telehealth, DPC, hybrid and in-person, any billing stack |
Burst doesn't connect to your stack. Your EMR, your scheduling, your subscription billing and your checkout all keep working, and there's nothing for your engineers to build.
Why Burst is the best HSA/FSA option for a telehealth or DPC practice
Burst files the claim. Clinician writes the letter. Burst submits it to the patient's administrator with the receipt and the dates. No paperwork for the patient.
No letter, no charge. Claim denied, money back. The $20 refunds automatically either way.
$100 a month, published. Month to month, no contract, no revenue share.
Monthly programs work without asking the patient to re-confirm. One letter, dated on or before the renewals it covers, and the claims get filed as the charges land.
With Truemed and Flex, the patient files the claim alone, the terms come through a sales process, and neither advertises a refund if the claim is denied.
See how it works or go live now.
What does it look like for a patient?
The patient pays you normally, then fills out a two-minute intake. A licensed clinician reviews it and, if appropriate, signs the letter, usually the same day. Their program keeps renewing on the card already on file. Burst files the claim. Their administrator pays them back by deposit or check. If the clinician doesn't approve, or the plan denies it, the $20 refunds automatically.
One timing rule: the letter has to predate the purchase, so put the link in the signup flow. The line that works on your site: "may be reimbursable with a letter of medical necessity."
What needs to be on the receipt?
The care in plain words, the patient's name, the date, the amount, and your practice named. "Dermatology consult" reimburses. "Membership, tier 2" doesn't, because nobody reading the claim can tell what was provided.
Split bundles into lines. A consult, a prescription and a device on one charge is the most common reason a telehealth claim comes back with questions. Itemized lines let the administrator pay the parts that qualify.
What do I tell patients?
In the signup flow, in four sentences:
"Your care here may be reimbursable with a letter of medical necessity through your FSA or HSA. We work with Burst. Two-minute intake, a clinician reviews it, and if they write the letter, Burst files the claim with your plan for you. It's $20 once, refunded if it doesn't go through."
Say "may be reimbursable," never "covered." The patient's plan decides each claim and you don't control it.
What does it do for retention?
A $120 monthly program costs a patient in a combined 30 percent bracket about $84 after reimbursement, and you still collect $120. Telehealth churn concentrates in the months where the patient re-evaluates the price, and this changes the number they're evaluating.
At $100 a month, Burst costs you $1,200 a year and never takes a percentage. On a subscription business, a rev share compounds every month a patient stays.
How to offer this at your practice
Sign up at getburst.com/self-serve. About 30 minutes, and your engineers aren't involved.
Decide who pays the $20 one-time letter fee: patients, or you as part of the first month.
Put your Burst link on the pricing page, in the signup flow, in the welcome email, and in the renewal notice.
Keep your checkout and billing exactly as they are. Patients enroll, get their letters, and Burst files their claims.
Introduce it at signup. A patient who hears about it in month four can't use it for the first three.
Frequently asked questions
What is the best HSA/FSA option for a telehealth brand?
Burst. It doesn't touch your checkout or your billing, it's live in 30 minutes, it costs $100 a month flat with no revenue share, and Burst files the patient's reimbursement claim. Truemed and Flex both require a sales call and a checkout integration on their card rails, don't publish their terms, and leave the patient to file alone.
What does Burst cost a merchant?
$100 a month, month to month, no contract, and never a percentage of your revenue, plus a $20 one-time letter fee per patient that you or the patient pays. There is no revenue share and no success fee.
Is telehealth HSA or FSA eligible?
Care for a condition a clinician is treating can be reimbursable with a letter of medical necessity. Optimization and cosmetic programs aren't. The patient's plan decides each claim.
Does it work for monthly programs?
Yes. Renewals keep running on the card on file through your existing billing, and claims are filed as the charges land. The patient isn't asked to re-confirm anything.
Do I have to change my checkout or my EMR?
No. Burst doesn't connect to either. Nothing in your stack changes.
Can a patient be reimbursed for months they already paid?
No. The letter has to be dated on or before the care it covers, so introduce it at signup.
Is the letter a guarantee the patient gets paid back?
No. The patient's plan administrator decides the claim under its own rules. Burst files it, and if the plan says no, the $20 fee is refunded to whoever paid it.
More for telehealth brands: HSA/FSA for Subscriptions and Memberships, Best HSA/FSA Option for Supplement Brands, Why HSA/FSA Cards Get Declined at Your Checkout, and Truemed Alternatives for Your Store, Gym, or Spa.
More in
