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# Customer journey: pre-approved products

> How customers pay for pre-approved HSA/FSA products at checkout, with no clinical intake form or Letter of Medical Necessity required.

Truemed allows customers to pay for pre-approved HSA/FSA products directly with their HSA/FSA card at checkout. Because the product category is pre-approved, no clinical intake form or Letter of Medical Necessity (LMN) is required. Customers complete their purchase using pre-tax HSA or FSA funds with no reimbursement filing needed.

---

## What "pre-approved" means

A product is pre-approved when its category already meets established regulatory standards for medical care, meaning customers can pay with their HSA or FSA card directly without additional clinical review.

### Core criteria for pre-approval

1. **Recognized eligible category (SIGIS / IRS-aligned).** Categories explicitly listed under SIGIS "Eligible: Devices & Supplies" qualify automatically. These are items with clear medical intent and established reimbursement precedent: diagnostic devices like thermometers and glucose monitors, durable medical equipment like crutches and wheelchairs, and condition-specific supplies like compression hosiery and breast pumps. Reference: [SIGIS Eligible Product List Criteria](https://sig-is.org/eligible-product-list/eligible-product-list-criteria).
2. **Meets IRS Section 213(d).** The product is used for diagnosis, cure, mitigation, treatment, or prevention of disease, or affects a structure or function of the body. Not for general health or wellness.
3. **Primary purpose is medical, not dual-purpose.** The product has a clear, singular medical use and would not be purchased for any other reason.
4. **Strong regulatory and TPA precedent.** Third Party Administrators consistently approve the category without additional documentation, and claim-denial risk is low.
5. **Fits cleanly into Truemed's eligibility framework.** Maps directly to an existing eligibility category with no clinical interpretation needed.

### What disqualifies a product from pre-approval

* General wellness items (vitamins, gym memberships, healthy food)
* Dual-purpose items (ergonomic chairs, mattresses, fitness equipment)
* Products that require personalization to a specific condition
* Products lacking clear IRS precedent
* Products that need clinical judgment to justify use

> **Note**
>
> **Pre-approved** = obviously medical, zero ambiguity, widely accepted by TPAs.
>
> **LMN required** = could be medical, but depends on the person, condition, or use case.

---

## Pre-approved vs. LMN flow: key differences

|                          | Pre-Approved Flow | LMN (Dual-Purpose) Flow     |
| ------------------------ | ----------------- | --------------------------- |
| Clinical intake form     | Skipped           | Required (60 to 90 sec)     |
| LMN issued               | No                | Yes                         |
| Practitioner review      | No                | Within 24 to 48 hours       |
| Payment capture timing   | Immediate         | After practitioner approval |
| Customer saves for audit | Receipt (3 years) | LMN + Receipt (3 years)     |
| HSA/FSA card at checkout | Yes               | Yes (after intake form)     |

---

## Customer journey

The journey for pre-approved products is shorter than the standard LMN flow because there is no clinical review step.

1. Customer sees HSA/FSA eligibility signaled on the product page
2. Customer adds items to cart and sees eligibility reinforcement
3. At checkout, customer selects **Truemed** as the payment method
4. The clinical intake form is skipped, and the customer enters their HSA/FSA card directly
5. Payment captures immediately
6. Customer receives a receipt and order confirmation (no LMN)
7. Customer saves the receipt for **3 years** in case of an IRS audit

---

## Edge cases

### What if the HSA/FSA card is declined?

For pre-approved products there is no clinical approval step, so the only failure scenario is a card issue (insufficient balance, TPA restrictions, card not activated for medical purchases). Troubleshoot as usual:

* Check the card's restrictions and TPA rules
* The customer can pay with a regular credit or debit card and submit the receipt for reimbursement through their HSA/FSA administrator

### What if the cart contains both pre-approved and LMN-required items?

If a customer adds both pre-approved and dual-purpose items to the same cart:

* The dual-purpose items trigger the standard LMN intake flow
* The pre-approved items do not generate an LMN independently
* The order processes based on each product's status

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## Need help?

* Customer support (your customers' questions): [support@truemed.com](mailto:support@truemed.com)
* Merchant support: [merchants@truemed.com](mailto:merchants@truemed.com)