Every category below turns on one clinical question: is there a diagnosed condition this actually treats? Answering it is the work — and the same answer, made once by a named physician, can carry pre-tax spend, a reimbursable service, and the care a family is already giving at home. A letter is only ever worth the physician behind it.
Open in the signed protocol (2026-09-11.1) means the criteria are written and signed by the Medical Director for the synthetic-case pilot; real member cases wait for the BAA and go-live gates. Next means a category is scoped for a future protocol revision — until the Medical Director signs its criteria, we do not offer it.
Gyms, studios, coaching, physio-adjacent programming. The largest dual-purpose category and the one the IRS watches hardest.
Medically tailored meals, dietitian programs, therapeutic nutrition. Food is the clearest case of a dual-purpose expense: everyone eats, so the diagnosis carries the whole argument.
The cleanest diagnostic anchor of any category — a sleep study is an unambiguous document, and the equipment maps to the diagnosis without argument.
TENS units, braces, compression, home traction. Some are already eligible without a letter; the value we add is telling a customer honestly which side of that line they are on.
CGMs, connected scales, remote monitoring programs. Adjacent to real reimbursement — the same attested record supports RTM billing on the clinical side.
Therapy platforms, digital CBT, substance-use programs. Therapy from a licensed provider is usually eligible outright; the letter question is about apps, coaching and adjuncts — and the privacy bar here is higher than anywhere else.
Pelvic floor rehabilitation, postpartum recovery programs, fertility tracking and treatment adjuncts. Under-served, heavily dual-purpose, and full of genuinely diagnosed conditions.
Air purification, hypoallergenic bedding, dehumidifiers. The oldest letter category there is, and the one where partners most often over-promise blanket eligibility.
Fall prevention, home modification, respite and companion care. The category where the person paying is almost never the person with the diagnosis — see below.
An HSA pays qualified expenses for the account holder, their spouse, and their tax dependents — which means an adult child can fund care for a parent who qualifies as a dependent, and a parent can fund care for a child. Nearly every product in this space assumes the buyer is the patient. The caregiver is the buyer far more often than the industry designs for.
The caregiver answers on the patient's behalf and says so. The relationship is captured, the affirmations are signed as proxy, and the physician sees exactly who reported what. A letter written on a daughter's guesses, presented as her father's own account, is the kind of thing that unravels in an audit.
Jurisdiction follows the patient, not the payer. A caregiver in Texas funding care for a parent in Ohio routes to a physician licensed in Ohio — the same rule as every other case, applied to the person receiving care.
One determination about one diagnosed condition can support the home modification, the mobility equipment and the companion hours that follow from it — each tied back to the same anchored record instead of three separate reviews.
Families under strain are the easiest people to sell a bad letter to. A written no with a reason is the most protective thing this product does, and it is why we will not run this category on percentage-of-sale economics.
Facilitating letters at checkout is not new. What decides whether the letters survive scrutiny is who signs them, how the reviewer is paid, and whether anyone outside the company can check the work.
The flat fee is the whole argument. A reviewer who earns more when approvals rise is the incentive an auditor looks for first; a reviewer paid the same either way has no reason to write a letter that is not true.
A Letter of Medical Necessity is one instance of a general problem: an AI system produces something clinically meaningful, and nobody's name is on it. Our physicians are not writing letters — they are attesting determinations, and a determination has many shapes.
Pre-tax spend across the categories above. One protocol, one receipt, one flat fee.
The same packet-and-attestation shape, aimed at a payer instead of a plan administrator.
An attested record is what makes monitoring billable; the physician's name is the billing requirement, not a formality.
One reviewer's decision, made once and anchored, can support several downstream expenses and reimbursements for the same person — including the care their family provides. See the full list →
Being listed on this page does not make anyone eligible. The but-for test is per person: performance, general wellness, cosmetic weight loss without a diagnosis, and anti-aging are refusals we have written down so they cannot quietly drift into the offer.
Eighteen qualifying conditions are signed in protocol 2026-09-11.1 (nine open on the Kinesis Integrated path, nine more in the general catalog). Categories marked next are scoped for future protocol revisions — until the Medical Director writes and signs their criteria, we do not take those cases. No BAA is executed yet; pilots run on synthetic data until the BAA and go-live gates clear.
The pre-screen runs in your brand and hands the customers who might qualify to a physician. Same widget, same flat fee, whichever category you are in.