HSA/FSA Eligibility Application

This application fee provides access to a third-party medical eligibility review through our chosen platform to determine whether an EMPULSE services or Burn training protocol may qualify for HSA/FSA reimbursement.

After checkout, you will receive a secure link to complete a confidential health intake. A licensed provider will review your information and determine eligibility.

How it works:

1. Purchase this application

2. Complete the medical intake using the link provided after checkout

3. A licensed provider reviews your information (typically within one business day)

4. If approved, you will receive a Letter of Medical Necessity (LMN)

5. Once approved, you may purchase Burn services and submit for HSA/FSA reimbursement

Important information:

This application does not guarantee approval.
This is not a purchase of training sessions, memberships, or services.
Empulse and Burn do not provide medical advice or determine eligibility.
All eligibility decisions are made by a licensed provider through the platform.
The application fee is non-refundable regardless of approval outcome.

If you are not approved, you may still choose to purchase Burn services as an out-of-pocket wellness program.

Why this step comes first:

Many HSA/FSA administrators require medical eligibility to be established before services are purchased. Completing this screening first helps prevent non-reimbursable expenses.

What happens after approval:

If approved, you will be cleared to purchase Empulse and Burn services and may submit your receipt and Letter of Medical Necessity to your HSA/FSA administrator for reimbursement.