Can you pay for sclerotherapy with an HSA?

If you have a high-deductible health insurance plan (HDHP) or are considering getting one, you may be wondering if you can save money by paying for sclerotherapy with the funds in your health savings account (HSA). You may also be wondering if this item is eligible or ineligible for reimbursement with your HSA, flexible spending account (FSA), or health reimbursement arrangement (HRA).

You may be able to use your HSA, FSA, or HRA to pay for sclerotherapy, but only if you have a letter of medical necessity.

Not sure what a letter of medical of necessity entails? Read on to see a sample!

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Example letter of medical necessity for sclerotherapy

If you're a doctor or other medical professional and you need a letter of medical necessity for sclerotherapy for one of your patients, you can use the template below as a starting point and customize it as you see fit.

If you're a patient and need a letter of medical necessity, send this page to your doctor so they can begin filling it out today.

[Doctor's Name]
[Doctor's Address]
[Doctor's City, State ZIP Code]

[Date]

[Insurance Company Name]
[Insurance Company Address]
[City, State ZIP Code]

Re: [Patient's Name]
[Insurance Policy Number]

To Whom It May Concern:

I am writing to request coverage for [patient's name]'s medical treatment, as I have deemed it medically necessary for their health and well-being that they receive treatment with sclerotherapy.

Patient Information:
[Patient's Name]
[Patient's Date of Birth]
[Diagnosis]
[Treatment Plan]

Explanation of Medical Necessity:

[Explain why sclerotherapy is medically necessary for the patient's health and well-being. Provide as much supporting evidence as possible, such as lab results, imaging, or medical history.]

[Include any other relevant information, such as the patient's previous treatment, their response to treatment, and the potential risks of not receiving the treatment.]

I strongly recommend that [patient's name] receives this treatment as soon as possible to ensure the best possible outcome for their health.

Thank you for your attention to this matter. If you require any further information or documentation, please do not hesitate to contact me.

Sincerely,

[Doctor's Name]
[Doctor's Title]
[Doctor's Contact Information]

Enclosure(s): [List medical results included as evidence of medical necessity]

Explore HSA eligibility for other products and services

HSA fast facts

Health savings accounts (HSAs) were created as part of the Medicare Prescription Drug, Improvement, and Modernization Act, or MMA, signed into law by President George W. Bush on December 8, 2003. The MMA was the largest overhaul to Medicare in the program's history.
HSAs are only available as part of a high-deductible health insurance plan (HDHP).
As part of the 2020 CARES Act, over-the-counter medications and menstrual care products are now eligible for purchase with health savings accounts (HSAs), flexible spending accounts (FSAs), and health reimbursement arrangements (HRAs). This list includes products like allergy medication, pain relievers, prenatal vitamins, and tampons.
Contributions to an HSA can be made by an employer and/or employee on a pre-tax basis. You can find current and historical HSA contribution limits on this site.
Funds in a health savings account can be invested in a similar way as other retirement accounts and are a rare example of an account that's triple tax advantaged. That is, funds are contributed pre-tax, can be withdrawn for eligible medical expenses without taxation, and if you invest the funds within your HSA the earnings or interest are tax free. Find out just how much you can save by investing your HSA funds using our HSA vs 401(k) vs Roth IRA investment calculator.
Funds can be withdrawn at any time for any reason, but funds withdrawn for non-approved medical expenses before the age of 65 are subject to income taxes and an additional penalty.
You can no longer contribute to an HSA once you're enrolled in Medicare.

Common HSA providers

Bank of America
Bend
BenefitWallet
Blue Cross Blue Shield
Cigna

Fidelity
Fifth Third
Further
HealthEquity
HealthSavings Administrators

HSA Authority
HSA Bank
Lively
Optum Bank
PNC

What about FSA and HRA eligibility?

The same HSA eligibility status for sclerotherapy applies to flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs) as well. However, while a high-deductible health insurance plan is required for an HRA, it is not required for an FSA.

Sources

Coming up with accurate eligibility status for the list of HSA eligible expenses can be a challenge at times. The IRS only provides a partial list of eligible expenses, so consumers and even insurance companies are left to wonder exactly what products are eligible.

To help illustrate this point, I had a visitor email me to ask if regenerative medicine such as platelet rich plasma (PRP) and stem cell treatments are HSA eligible. I did extensive research and the answer pointed toward "probably not but check with your provider to see if they'll cover it." So I suggested that he consult them for guidance. His response was that he did and even they didn't know!

In a case like that, I would suggest getting a definitive answer in writing from your provider. If you can't get one, the safe choice is to assume it's not eligible and not expense it.

There are also cases where one source says an expense is eligible and another says it's not. In those cases I do my best to research the expense further and come up with an answer that seems most likely for the greatest number of providers.

At any rate, these are the primary sources I use for expense verification. Keep in mind this is not an exhaustive list, and I will frequently check product manufacturer websites for eligibility statuses, as they often will have done their own due diligence if they suspect people may want to use their HSA or FSA to pay for their products and they fall into the uncertain category.

Disclaimer

This page is intended to be an educational reference only. Please check with your HSA administrator or health insurance provider to confirm if you can pay for sclerotherapy with your HSA card before making any purchases.

A good rule of thumb is that if your doctor diagnosed you with a specific medical condition or ordered a treatment, product, or prescription specifically for you, your health savings account should cover it. Sometimes your HSA will even cover items that it normally wouldn't if you have a letter of medical necessity signed by your doctor. Again, you should check with your HSA administrator before any purchase if you have any questions about an item being eligible or ineligible.

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