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Dr. Trust Me BroDr. Trust Me BroIndependent data journalism · wry humor
Patterns

The FSA/HSA loophole

A recurring pattern in the scans: services insurance will not cover, sold as reimbursable through your FSA or HSA, by practices that quietly refuse Medicare and Medicaid.

The pattern in plain language
Read enough wellness practice pages and a script emerges. The treatment, panel, or consultation is not covered by insurance. That is not pitched as a problem. It is pitched as a feature, proof that the care is too cutting edge for a stingy system. And then comes the helpful aside: you can pay with your FSA or HSA. The bill that insurance refused to touch is suddenly framed as reimbursable, just through a different door.
Why this is worth a second look
FSA and HSA dollars are tax advantaged. They are meant for qualified medical expenses, with the account holder responsible for substantiating that the expense qualifies. When a practice steers you to those funds for a service insurers decline to cover, it is leaning on your account, and your paperwork, to capture money that the practice could not collect through a normal claim.

What the scans show

Across 110 doc bros whose payment and insurance posture was assessed.

31%
34 of 110 Doc Bros
Promote paying with FSA/HSA
Tell patients they can use tax advantaged account funds.
44%
48 of 110 Doc Bros
Say insurance will not cover it
Frame non-coverage as a feature of the care, not a flaw.
32%
35 of 110 Doc Bros
Decline Medicare/Medicaid
Stay outside the program rules and audit authority.
21%
23 of 110 Doc Bros
Both: skip Medicare, push FSA/HSA
The core pattern: no government claim, but route the tax break.
5%
5 of 110 Doc Bros
Steer to FSA/HSA card at checkout
Pay at point of sale, no reimbursement claim to review.
31%
34 of 110 Doc Bros
Patient-as-cutout pattern
Decline government payers, sell non-standard care, route the funds through the patient.
Card swipe vs. submitting a receipt

There are two ways FSA and HSA money reaches a practice, and they are not the same. Swiping an FSA or HSA card at checkout moves the money at the point of sale, with no claim filed and little review at the moment of payment. Submitting a receipt or superbill for reimbursement creates a record that an administrator, and the account holder, can examine against the rules for qualified expenses. Steering patients toward the card and away from the reimbursement route is the quieter path. It is the difference between a transaction that just happens and one that someone might question.

Why the same practices skip Medicare and Medicaid
Here is the part that ties it together. Many of the same practices that will not bill private insurance also do not accept Medicare or Medicaid. Opting out is legal and common. But it is worth noticing what it avoids. Billing a government health program puts a provider under that program's rules and audit authority, and submitting claims for services that are not medically necessary or not standard of care is exactly the kind of conduct the False Claims Act exists to punish. A practice selling care that insurers consider unproven has a strong incentive to never send that claim to the government in the first place.
The patient as a cutout

Put the pieces together and the structure is striking. The practice funnels a patient into a service, then points that patient at their own tax advantaged account to pay for it. The patient, not the practice, becomes the party who interfaces with the government's tax benefit and who is on the hook for whether the expense qualifies. The practice has inserted a cutout between itself and the public funds. It reaches tax advantaged dollars it could not have billed for directly, while the patient carries the substantiation risk and the government program never sees a claim it could scrutinize.

Seen in the wild

Representative notes and quotes pulled from analyzed scans.

This is a concierge service for people who are ready to go deep on their health and finally get the answers they’ve been looking for. No more guessing, this is your last stop.

Practice is cash-pay / concierge with no insurance billing

From the Stephen Cabral scan

We take the time conventional medicine won't.

Practice is cash-only and does not accept insurance, framing it as a way to avoid bureaucracy.

From the Anna Payne scan

A half-hour consultation is $100

Cash-only consults and treatments not covered by insurance

From the Joshua James Redd scan

Starting at Momentum Health is simple. We make it easy to get the information you need and get booked with the right doctor for your situation.

Practice is cash-only and does not accept insurance.

From the Todd A Anderson scan

We operate outside insurance so pricing is clear and predictable. Many students use HSA/FSA funds. Check with your plan administrator. We provide an itemized receipt.

Explicitly states they operate outside insurance and provide itemized receipts for HSA/FSA reimbursement.

From the Josh Axe scan

Accessible pricing. Transparent memberships and flexible financing keep high-level functional medicine within reach

Explicitly states they do not accept insurance and offer 'transparent memberships'.

From the Tanner Wilson scan

Insurance may cover some testing and services but not all. This program in general is considered to be above standard care and therefore elective as far as the insurance industry is concerned.

Explicitly states 'We do not accept insurance' and that functional medicine is 'above standard care' and 'elective'

From the William Cole scan

Our network of Health Restoration Clinics that think and act differently to solve the health challenges others can’t.

The clinic is a cash-pay network of 'Health Restoration Clinics' that does not bill insurance.

From the Patrick Flynn scan

I've created tools, books, and programs so women everywhere can have access to the information they're not being given anywhere else.

The practice is cash-only, not accepting insurance, and promotes FSA/HSA as a payment method.

From the Jolene Brighten scan

We do not accept insurance. And, here's why. Insurance companies decide how long and what type of care physicians can provide to their patients.

Explicitly states they do not accept insurance or Medicare, framing it as avoiding limits on care.

From the Gloria Hamada scan

Dr. Josselson sees patients in her New Jersey office. Phone and Zoom consultations are now available for all appointments.

Cash-only practice with no insurance billing.

From the Melissa Josselson scan

All for less than it would cost to meet my deductible

Cash-only practice that does not accept insurance

From the Momentum Health & Wellness Minnesota scan