Real Patient Story: How Sarah Got $2,400 in Back Pain Treatment Reimbursed

Names and identifying details changed. Reimbursement amounts and process steps are accurate.

Sarah is 34, works in marketing, and has had chronic lower back pain since a fall in 2023. After two rounds of physical therapy and a brief MRI scare (no surgery needed), her primary care doctor told her the same thing every back pain patient eventually hears: "You need to keep moving. Strength training, Pilates, low-impact cardio. Make it part of your routine."

She did. Gym membership, weekly Pilates, occasional personal training. About $200/month all-in.

What she didn't realize for two full years: her HSA account could have been paying for almost all of it.

The Realization

A friend in her Pilates class mentioned that her HSA had reimbursed her own personal training. Sarah was skeptical. She'd heard "HSA" and assumed it covered prescriptions and copays — not gym memberships.

After about 30 minutes of research, she discovered IRS Publication 502 and the Letter of Medical Necessity pathway. Her diagnosis (chronic low back pain, ICD-10 M54.5) was textbook qualifying.

What She Did

1. Logged into her patient portal and confirmed chronic back pain was on her active diagnosis list.
2. Got an LMN packet prepared — clinical summary, draft letter, and a portal message her doctor could approve in under a minute.
3. Sent the packet to her PCP through MyChart. Her doctor edited two sentences and signed within 5 days.
4. Pulled receipts from the past 12 months — gym membership, Pilates studio, three personal training packages.
5. Submitted to HealthEquity (her HSA admin) with the signed LMN.

The Result

Expense	Annual cost	Reimbursed
Gym membership ($60/mo)	$720	$720
Pilates ($120/mo)	$1,440	$1,440
Personal training (occasional)	$240	$240
Total	$2,400	$2,400

Reimbursement landed in her HSA-linked checking account 12 days after submission. Because HSA contributions are pre-tax, her actual savings — money that stayed with her instead of going to taxes — was about $720 (at her ~30% effective tax rate).

The Twist

Sarah had also forgotten about an inversion table she'd bought during a particularly bad flare-up the previous year — $400 from Amazon. With the LMN dated to cover that period, that expense became reimbursable too.

Total reimbursement for year one: $2,800.

What She Would Do Differently

"I wasted two years not knowing this was an option. The biggest thing is just realizing the framework exists. Once I knew, the actual process was the easiest part."

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Got chronic back pain (or any qualifying condition)? Start your packet — your own doctor signs, compliance-reviewed within 1 hour.