Your psychiatrist can prescribe exercise, sleep, and recovery.

Yes, with conditions. Under IRS Publication 502, services like massage therapy, acupuncture, pilates, and gym memberships are eligible medical expenses when prescribed in writing by a licensed clinician to treat a specific diagnosed medical condition. The LMN is what makes the expense eligible. Without it, the IRS considers the expense personal and disallows it.

Our role is the clinical encounter and the documentation that comes out of it. You meet with Dr. Al-Katib. If you have a diagnosable condition and a treatment plan that includes one of the items on our formulary, we issue the LMN.

We do not handle your purchases. We do not submit anything to your HSA administrator. We do not receive any of your reimbursement. Your benefits relationship stays between you and your plan.

It is uncommon when an LMN is on file, but it does happen. The most frequent reasons are missing the item-specific clinical rationale, an outdated LMN (LMNs are typically valid for one tax year), or an item the administrator interprets as personal-use even with prescription.

If yours is rejected, we will revise the letter at no charge for up to 12 months from the original visit. If the administrator still rejects after revision, we refund the $199 protocol fee.

No. Tax avoidance and tax evasion are not what this is. Section 213 of the Internal Revenue Code explicitly allows medical expenses, including doctor-prescribed treatments, to be paid with HSA or FSA dollars or itemized.

Exercise, sleep technology, and somatic therapy are well-established medical treatments for the conditions we treat. The IRS requires documentation. We provide the documentation when it is clinically appropriate. When it is not, we tell you, and we do not write the LMN. That is the entire structure.

The same LMN works for HSA, FSA, and most HRAs. The underlying eligibility standard (§213 medical expense) is the same across all three. A few HRAs have plan-specific exclusions on top of the IRS list — those are set by your employer’s plan document, not by the IRS. If your HRA rejects an item your HSA would approve, that is a plan-design limitation, not an LMN problem.

No. Documentation has to be contemporaneous with the encounter and the treatment plan. We will not backdate an LMN.

If you saw us this year and have already paid for eligible items this same tax year, the LMN can cover those expenses up to your visit date and forward — many HSAs accept reimbursement for the current tax year if the LMN is signed before you file. Last year’s expenses are closed.

Most administrators treat an LMN as valid for one tax year from the date of signing. A recurring condition (chronic ADHD, treatment-resistant depression, chronic low back pain) typically warrants annual renewal. A few administrators accept multi-year LMNs for stable chronic conditions. We renew at the annual encounter if clinically appropriate.

For the same condition and same items, an annual renewal at your follow-up encounter is standard practice. If your condition resolves or changes, the LMN does not auto-renew. If you add a new item to your protocol mid-year (say, you start pilates after only being on the gym list), that addition needs its own item-specific rationale.

The LMN follows you. It documents a clinical relationship between you and Dr. Al-Katib, not your employer. HSAs are individually owned and portable. FSAs and HRAs belong to your old employer’s plan and typically end with the employment. If your new plan is also HSA or FSA eligible, the same LMN works for the rest of the tax year.

No. An LMN documents your diagnosis and your treatment. Family members who want HSA reimbursement for their own eligible expenses need their own encounter and their own LMN if their item requires one. The exception is that family members on your HSA can use the account for their own §213-eligible expenses that do not require an LMN (most prescription medications, doctor visits, etc.).

HSAs cover your out-of-pocket portion — copays, coinsurance, expenses your insurance denied as out-of-network. If insurance paid in full, there is no HSA-eligible balance for that expense. If you used insurance for a $200 PT visit and your copay was $40, the $40 is HSA-eligible. The LMN matters for items insurance does not normally cover (gym, sleep tech, pilates) where the LMN is what unlocks eligibility in the first place.

No. The LMN goes to your HSA or FSA administrator, not your employer’s HR department, even when HR sponsors the plan. Administrators are bound by federal privacy rules — they cannot share the medical detail with the employer. What HR sees is that you submitted an eligible expense and what plan account it came from. They do not see the condition.

We are licensed to practice in NY, FL, and NJ. If you move to a state we are not licensed in, we cannot continue prescriptive care from a distance. We will refer you to a vetted colleague in your new state if you want continuity, and your existing LMN remains valid through its expiration date for expenses incurred during the period it covered.

The most-rejected category in our experience is broadly worded “wellness” items where the clinical rationale on the LMN is too generic. Sleep tracking devices for someone without a sleep disorder diagnosis. Gym memberships for someone with no metabolic or psychiatric indication. We avoid this by tying each item to a specific ICD-10 coded diagnosis and a specific clinical rationale before the letter is signed.

An HRA is an employer-funded benefit account that reimburses qualifying medical expenses. The IRS eligibility standard for an HRA is the same as for an HSA or FSA (§213), so the same LMN you would use for an HSA generally works for an HRA. The difference is who owns the account and the specific exclusions your employer chose to include in their plan document.