Key takeaways

• In the US, your patients can pay for Nerva with HSA or FSA funds using a Letter of Medical Necessity (LMN) from a licensed healthcare provider – which can include you.
• IBS is a diagnosed medical condition, so managing it is a qualified medical expense under IRS rules.
• The process is simple for patients: subscribe to Nerva, obtain an LMN, then submit the receipt to their plan administrator.
• Eligibility rules vary by plan, so patients should confirm details with their HSA or FSA administrator first.

Making Nerva more affordable with pre-tax dollars

In the US, your patients can pay for Nerva with HSA or FSA funds, as long as they have a Letter of Medical Necessity (LMN) from a licensed healthcare provider confirming that Nerva is recommended to manage their IBS or another gut-brain disorder. Requirements vary by plan, so it's worth advising patients to check with their plan administrator before they submit.

For patients who have been managing IBS for a while – sometimes for years on end – the costs add up quickly. Using pre-tax HSA or FSA dollars is one of the simplest ways to make an evidence-based program like Nerva more affordable for them.

What is an HSA or FSA?

An HSA (Health Savings Account) and an FSA (Flexible Spending Account) are both tax-advantaged accounts that let patients pay for qualified medical expenses with pre-tax dollars, which effectively lowers their out-of-pocket cost.

HSA (Health Savings Account)

An HSA is a savings account available to patients enrolled in a high-deductible health plan (HDHP). The funds roll over year to year, the account stays with the patient if they change jobs, and the 2025 contribution limits are $4,300 for an individual and $8,550 for a family.¹ Roughly 40 million HSAs now cover an estimated 59 million Americans, or about 1 in 4 working adults.²

FSA (Flexible Spending Account)

An FSA is an employer-sponsored account that doesn't require a high-deductible health plan. The main catch is that FSAs are generally "use-it-or-lose-it" each year, with only a limited carryover allowed (around $660 for 2025), and the 2025 contribution limit is $3,300.¹ For patients with unspent FSA funds late in the year, putting them toward IBS management is a practical way to use them before they expire.

Why Nerva is eligible for HSA or FSA funds

Nerva is eligible because IBS is a diagnosed medical condition, and the IRS treats spending on the diagnosis, treatment, or prevention of a medical condition as a qualified medical expense under Section 213 of the tax code.³

A solution doesn't have to be a prescription drug to qualify, but it must be for a genuine medical purpose rather than general wellness.

IBS is one of the most common gut-brain disorders, affecting an estimated 10 to 15% of people worldwide, and it is formally recognized by the Rome Foundation as a disorder of gut-brain interaction.⁴ Because the symptoms trace back to a real, diagnosable condition, it's on solid footing as a medical expense rather than a lifestyle purchase.

"Symptoms are very real and they are driven by what happens between the gut and the brain and the brain to the gut along what's called the brain-gut axis." – Dr. Megan Riehl, GI Psychologist, Clinical Director of the GI Behavioral Health Program, University of Michigan

Using digital therapeutics to manage a diagnosed condition is increasingly recognized for HSA and FSA reimbursement when accompanied by a Letter of Medical Necessity. The key is documentation: your patient's plan administrator needs to see that the expense is tied to managing their IBS.

How much your patients can potentially save using their HSA or FSA for IBS support

If a patient opts to pay for a 12-month subscription to Nerva's gut-brain therapy program with their HSA or FSA, their pre-tax dollars will stretch further – most Americans save about 30%. When you refer a patient to Nerva, they save even more.

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Pay for Nerva with an HSA or FSA

• Standard price $199/yr → ~$139/yr (about $60 back)
• With a provider referral $149/yr (25% off the standard price) → ~$104/yr (about $95 back total)

Nerva is an annual subscription ($199 USD/year) and is HSA/FSA eligible. Actual savings depend on the patient's tax bracket, state taxes, and payroll setup. ~30% is a common average, not a guarantee. Patients should consult a tax professional.

How patients pay for Nerva with their HSA or FSA in 3 steps

Paying for Nerva with HSA or FSA funds is a reimbursement process, which means the patient pays first and then claims the cost back from their account.

1. Subscribe to Nerva using any regular payment method.
2. Get a Letter of Medical Necessity from their doctor, gastroenterologist, or another licensed healthcare provider, stating that Nerva is recommended to manage their IBS or other gut-brain disorder.
3. Submit the Nerva receipt and the Letter of Medical Necessity to their HSA or FSA plan administrator for reimbursement.

Because requirements vary by plan, advise patients to check with their administrator to confirm what they need before submitting, so the claim isn't held up.

What is a Letter of Medical Necessity (LMN)?

A Letter of Medical Necessity (LMN) is a short document from a licensed healthcare provider that states the patient's diagnosis and explains why a specific treatment is recommended.⁵ It's the piece of paperwork that connects the Nerva subscription to the patient's IBS, which is what most plans need to approve the expense.

A strong LMN usually names the diagnosis (for example, IBS), identifies the recommended approach (Nerva), and confirms it is being used to directly address that condition rather than for general wellness. Any provider treating the patient can write one, including a primary care doctor, gastroenterologist, nurse practitioner, dietitian, or psychologist.

How does Nerva help IBS?

Nerva is a gut-brain therapy program that uses gut-directed hypnotherapy and evidence-based techniques to target the overactive gut-brain communication that drives IBS symptoms. It's a structured 6-week program designed to be completed in just 15 to 20 minutes a day, and it aligns with guideline-recommended, first-line behavioral therapies for IBS.⁶

In Nerva's randomized controlled trial, 81% of participants achieved a clinically significant improvement on the IBS Symptom Severity Scale, and 71% had a clinically significant reduction in abdominal pain.⁷

Nerva is offered as an annual subscription, and patients referred through a clinician automatically receive 25% off, bringing the cost to $149.25 – comparable to a single GI psychology session for 12 months of access.

Every patient starts with a 7-day free trial, and there's a 42-day money-back guarantee for added peace of mind.

Frequently asked questions

Is gut-directed hypnotherapy HSA eligible?

Gut-directed hypnotherapy can be HSA or FSA eligible when it's used to treat a diagnosed medical condition such as IBS and the patient has a Letter of Medical Necessity from a licensed provider. Nerva delivers gut-directed hypnotherapy as part of a structured program, so the same documentation pathway applies.

What if a patient's HSA or FSA plan rejects their Nerva claim?

A rejected claim is often a documentation issue rather than a final decision, so the patient should ask their administrator what was missing before resubmitting. A clearer Letter of Medical Necessity that names the IBS diagnosis and the treatment recommendation usually resolves it.

Can a patient use their FSA before the end of the year on Nerva?

FSA funds are typically use-it-or-lose-it, so spending them on Nerva before the plan's year-end deadline is a practical way to avoid forfeiting them. Patients should confirm their specific deadline and any carryover allowance with their administrator, since these vary by plan.

Does a patient need a new Letter of Medical Necessity to renew Nerva each year?

Many plans require a current Letter of Medical Necessity for each benefit year, so patients may need an updated letter when their annual Nerva subscription renews. They should check with their administrator on how often the documentation needs to be refreshed.

What if you haven't recommended Nerva before?

You don't need prior experience with Nerva to write a Letter of Medical Necessity – only to confirm the patient's IBS diagnosis and that gut-brain therapy is a reasonable approach. Nerva is a guideline-aligned gut-brain therapy program, and our clinician resources can help you complete the letter.

References

1. Internal Revenue Service. Rev. Proc. 2024-25: 2025 inflation-adjusted amounts for Health Savings Accounts and high-deductible health plans. IRS; 2024.
2. Devenir Research. 2024 Year-End HSA Market Statistics & Trends. Devenir; 2025.
3. Internal Revenue Service. Publication 502: Medical and Dental Expenses (Section 213 qualified medical expenses). IRS; 2025.
4. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders: results of the Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.
5. GoodRx. What is a Letter of Medical Necessity? GoodRx Health; 2024.
6. Lacy BE, Pimentel M, Brenner DM, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44.
7. Mindset Health. Nerva randomized controlled trial: gut-directed hypnotherapy for IBS. Mindset Health; 2024.