Use It or Lose It?
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At first glance, the phrase “use it or lose it” seems equally applicable to physical function, cognitive health, and employee benefits. In the world of health spending accounts, however, the phrase has a narrower and frequently misunderstood meaning.
The final quarter of the year is an appropriate time for podiatric practices to remind patients to review their health benefits and assess whether their current custom foot orthoses still meet their needs. That conversation can improve treatment adherence, help patients avoid forfeiting eligible Flexible Spending Account funds, and create a well-timed opportunity to address worn devices, changing symptoms, and footwear-specific needs.
The purpose should not be to create urgency where none exists or to encourage patients to purchase devices they do not need. The purpose is to identify legitimate clinical needs, explain the patient’s payment options accurately, and complete medically appropriate care within the applicable plan deadlines.
THE KEY DISTINCTION
FSA funds may be subject to a plan-year deadline. HSA funds roll over from year to year and do not expire.
FSA FUNDS MAY EXPIRE. HSA FUNDS DO NOT
A health Flexible Spending Account, or FSA, is generally offered through an employer and funded with pretax dollars. Many FSAs are subject to a “use it or lose it” rule, meaning that unused funds may be forfeited after the plan year. Some plans permit a limited carryover or a grace period, and the plan year is not always the same as the calendar year. Patients should confirm their deadline and plan-specific rules with their FSA administrator.
A Health Savings Account, or HSA, works differently. An HSA is individually owned, is generally available to people enrolled in an HSA-eligible high-deductible health plan, and remains with the account holder. Unused HSA funds roll over from year to year and do not expire. Therefore, it is inaccurate to tell patients that their HSA dollars must be spent by December 31. HSA funds can still be a valuable way to pay for qualified medical expenses, but there is no “use it or lose it” deadline.
Both accounts may provide tax-advantaged payment for qualified medical expenses. Custom prescription foot orthoses may be eligible when they are prescribed to diagnose, treat, mitigate, or prevent a medical condition or to affect a structure or function of the body. Eligibility and documentation requirements can vary, however, so a practice should never guarantee reimbursement. The patient should confirm eligibility with the plan administrator, and the practice should be prepared to provide an itemized receipt and appropriate medical documentation.
INSURANCE COVERAGE AND ACCOUNT ELIGIBILITY ARE SEPARATE QUESTIONS
Whether an insurance plan covers custom orthotics is not the same question as whether the patient may use FSA or HSA funds to pay for them. An insurance policy may exclude orthotics, limit coverage to certain diagnoses, restrict replacement frequency, or consider an additional pair noncovered. That does not automatically make a medically prescribed device ineligible for FSA or HSA payment. Conversely, possession of an FSA or HSA debit card does not guarantee that every orthotic order will qualify.
This distinction should be explained clearly. When the device is not covered by insurance, the practice should provide a written estimate and follow its established financial policy. Many offices collect the patient-responsibility amount in full when the order is placed. The clinical record should identify the diagnosis, the reason for the device, and why a replacement or additional pair is appropriate.
WHEN A SECOND PAIR HAS A CLINICAL PURPOSE
A second pair of orthotics is sometimes described as a convenience, but convenience and adherence are closely related. Patients are more likely to wear their prescribed devices when the orthotics fit the footwear they actually use and do not have to be moved repeatedly from one pair of shoes to another.
- An exact or closely matched duplicate for a second pair of frequently worn shoes
- A lower-volume device for dress or fashionable footwear
- A more durable design for work boots or occupational footwear
- A sport-specific device for running, tennis, pickleball, basketball, golf, cycling, ski boots, or cleated shoes
- A device with different cushioning, posting, accommodation, or offloading for a particular activity or shoe environment
- A replacement for an orthotic that is worn, damaged, lost, or no longer matches the patient’s current condition
The prescribing clinician should decide whether the second pair should duplicate the original prescription or be redesigned for a different shoe and activity. An older prescription should not be copied automatically without reviewing the patient’s symptoms, device wear, footwear, activity level, and current examination findings.
KevinRoot Medical can fabricate matched duplicates as well as dress, sport, work, and specialty orthotics based on the clinician’s prescription. When prior order details are available through KevinRoot Medical or FootID Pro, the practice can review the successful elements of the original device and specify any changes needed for the new footwear or activity. The laboratory supports the fabrication process, while the treating clinician retains responsibility for the medical indication and prescription.
A PATIENT-CENTERED YEAR-END WORKFLOW
A year-end orthotic program works best when it is organized as a clinical recall and education process rather than a sales campaign.
- Identify patients who may benefit from review. Look for patients whose devices are worn, whose symptoms or activity level have changed, who use multiple types of footwear, or who previously asked about a second pair.
- Use accurate outreach language. Ask patients whether they have unused FSA funds with a plan-year deadline. Do not state that HSA funds expire. Remind patients that eligibility varies and that they should confirm their own plan rules.
- Start early enough for evaluation, fabrication, and delivery. Merely ordering or prepaying for an orthotic before year-end may not satisfy an FSA deadline. Many administrators consider an expense incurred when the medical service or product is actually provided, not when payment is made. Practices should establish an order cutoff that allows adequate time for the device to be completed and dispensed, and patients should verify the applicable rule with their administrator.
- Reevaluate before reordering. Inspect the current orthotics, review the patient’s response, confirm the intended footwear, and document any prescription changes.
- Explain the financial arrangement in advance. Clarify whether insurance will be billed, whether the device is noncovered, what the patient will owe, and when payment is due. Avoid representing FSA or HSA eligibility as insurance coverage.
- Provide useful documentation. An itemized receipt should identify the product or service, date provided, and amount paid. When requested, provide the prescription or a letter explaining the medical purpose. The patient remains responsible for submitting documentation and confirming reimbursement.
- Close the loop after delivery. Confirm fit, function, comfort, and compatibility with the intended shoes. A second pair is valuable only when it is dispensed properly and used as prescribed.
TIMING MATTERS
For many FSAs, the relevant date may be when the orthotic is provided to the patient, not when it is ordered or prepaid. Build outreach and laboratory cutoffs around delivery, and ask patients to verify their own plan rule.
SAMPLE PATIENT MESSAGE
“As the end of your benefit year approaches, you may have unused Flexible Spending Account funds that are subject to your plan’s deadline. Custom prescription foot orthotics may be an eligible medical expense when medically indicated. If your current orthotics are worn, your needs have changed, or you would benefit from a clinically appropriate pair for work, dress, or sport shoes, please schedule an orthotic review by [date]. Health Savings Account funds do not expire, but they may also be used for qualified medical expenses. Eligibility, deadlines, carryover rules, and documentation requirements vary by plan, so please confirm the details with your account administrator.”
Practices can adapt this language for email, text messaging, a website notice, a newsletter, or front-desk signage. The message should educate without promising coverage or pressuring the patient.
THE OPPORTUNITY, PROPERLY FRAMED
A thoughtful year-end review can benefit both the patient and the practice. Patients may preserve FSA dollars that would otherwise be forfeited, obtain a replacement before a worn device fails, or receive an orthotic designed for footwear they use every day. Practices can improve compliance, provide a higher level of service, and receive clear payment for noncovered care.
The most effective message is not simply, “Spend the money before it disappears.” It is, “Let us make sure your orthotic therapy still fits your feet, your footwear, and your life.” When accurate benefits education, sound clinical judgment, proper documentation, and dependable laboratory support come together, year-end planning becomes good patient care rather than a promotion.
