Experience with HSAs

(czechm1) #1

I am new to DPC and realizing we have a fair number of patients with an HSA. They are asking their insurance reps, etc like I have recommended. The problem I’m running into is many patients would love to follow me but are finding it difficult because of the HSA issue. I know this is a grey area but I would love to hear what other practices are doing out there?

(Dr Mark Turshen) #3

I explain the current issue re: IRS and the fact that, at some point, there may be a change in the law. Right now, I have many patients who still use their HSA and don’t think anyone has been denied by their TPA.

I’ve also never had anyonenot join because of HSA issues specifically. Not sure if the patients you’re describing still “don’t get it,” as the value you’re presenting is worth a lot more than the tax break they’d be getting.

(Zak Holdsworth) #5

@philsq @jpkeese thoughts on this from the legal/regulatory perspective?

(Dr Phil Eskew, DO, JD, MBA) #6

I don’t support this method because it does not accurately represent the DPC transaction. Any opposing attorney would point out that a large portion of the value was for ongoing care. If all the money were truly for an annual physical then you would have no obligation to see them beyond a single visit without charging them an additional fee.

(Robin Dickinson) #7

I always explain the situation if they ask and that they should discuss it with their tax professional. But my patients all enter their own card on the patient portal so I never see or touch it so if they choose to use an HSA anyway, I wouldn’t know. Hopefully this will all get sorted out soon so it won’t be an issue.

I do know several people who just charge for an annual physical and even though it’s fuzzy legally as @philsq says, I don’t think anyone has ever been sued for it. I don’t do it myself because I like keeping everything simple and clean.

(Chad Weston) #8

So to clarify… @philsq, patients can maintain and contribute funds to their HSA and simultaneously cover their monthly membership with funds outside of their HSA? Would a gray area be providing the patient with a codified superbill for their ’ home visit /wellness exam" for the patient to then submit for HSA reimbursement, thus covering a portion of the annual membership and then charging a lowered monthly retainer membership rate?

(Dr Phil Eskew, DO, JD, MBA) #9

Nope. That would not work in the eyes of the IRS. Your solution is focused only on the “medical expense” problem and not the “gap plan” problem. Being a member of a DPC practice creates a “gap plan” problem.
See my full explanation here http://www.dpcfrontier.com/tax-treatment/

(Siobhan Benham) #10

I was wondering if in the “tax overhaul “ this was addressed? Any changes in the HSA / DPC Relationship from the IRS?

(Lynn Ho) #11

Hello ! starting up my DPC transitioning from insurance based micropractice to direct January 1st.
I read Dr Eskews page on insurance/HSA/DPC, and would like to provide an option for patients paying an annualized fee for annual PE or acute visit, whichever comes first in the year, scheduled as FFS visit with global period f/u.
I am starting up my practice downstairs from Lauren Hedde and Mark Turshen, and I copped a page from their patient contract and would like to modify it as follows -

might this work?

(h) Monthly Fee Schedule. Patients age 21-49 will pay $30, age 50 and up will pay $35, age under 25 with a parent subscription will pay $10, and age under 21 joining alone will pay $25. Homebound fee determined on a case-by-case basis.


(h)Annualized Fee Schedule (for patients using HSA/FSA). Patients age 21-49 will pay $360/yr, age 50 and up will pay $420/yr, age under 25 with parent subscription will pay $120/annum and age under 21 joining alone will pay $300/yr. Fees will be referable to and charged on the first visit of the calendar year or the annual health maintenance visit, whichever event occurs first.

thanks for any input !
Lynn Ho

(Lynn Ho) #12

Oops ! I see that this question already answered in HSA/FSA section
looks like no go, due to clearly the intent is payment for ongoing care even though on paper it looks like it could just be fee for service on the paperwork
I guess still waiting for primary care enhancement act , sort of like waiting for Godot