Your patients have FSA money that expires December 31. The next 30 days are when to tell them
Many flexible spending accounts are use it or lose it at year end. A 30-day plan to remind patients, fill November and December, and stay HIPAA safe.
Every December some of your patients lose money they set aside for their own care. They put pre-tax dollars into a flexible spending account in January, used a little of it, and forgot the rest. On December 31 a lot of those balances simply disappear.
That is a problem for them and an opening for you. Chiropractic care is generally an eligible FSA expense, and most patients do not think of it when they are scrambling to spend a balance on contact lenses and first aid kits. The next 30 days are the window to put your practice on their list before the holiday rush eats their attention.
First, get the rules right so the front desk does not overpromise
FSA rules are set by the employer within IRS limits, so they vary. Some plans are strictly use it or lose it at December 31. Some allow a limited carryover into the next year. Some give a grace period that runs into March. A patient with an HSA has a different account entirely, and that money does not expire.
So your message should never say "your money expires." It should say "if your plan is use it or lose it, check your balance." Let the patient look it up. The IRS publication on health accounts is the primary source if anyone on your team wants to read the detail.
Also confirm with your billing person how you document visits for FSA reimbursement. Have a clean receipt template ready before you send a single message.
Week one: build the list
Pull every active and recently active patient. Recently active means a visit in the last 12 months. Then sort by what you know:
- Patients who have used an FSA or HSA card at your desk this year.
- Patients on a care plan who paused it in the summer or early fall.
- Patients who finished a plan and never booked a maintenance visit.
The first group is your warmest. They already know the card works with you. The second group is your biggest opportunity, because they have a reason to come back and a balance that might pay for it.
Week two: the message, word for word
Send one text to the whole list. Keep it about money and calendar, never about their condition. A text that names a diagnosis and lands on a reassigned number is a disclosure you do not want.
"Hi [first name], this is [name] at [practice]. Quick year-end reminder: if your FSA is use it or lose it, visits here are usually an eligible expense. We are holding a few spots in November and December. Want me to save you one?"
Four days later, send a specific offer to anyone who did not reply:
"I have Tuesday at 7:30 a.m. and Thursday at 5:00 open next week. Either one work for you?"
That is it. Two texts. The second gives the patient a decision, not a project. The same principle drives the reactivation sequence in our slow season guide.
Week three: say it at the desk and on Google
Every patient who checks out in the second half of October and early November should hear one sentence from the front desk:
"If you have FSA money left this year, a lot of people use it to book their next few visits before December. Want me to put those on the calendar now?"
Then book the visits on the spot. A visit on the calendar survives the holidays. A visit someone means to call about does not.
Add one Google Business Profile post the same week. Title it something plain like "Using your FSA before year end" and explain in three sentences that visits are generally eligible and patients should check their plan. The Google Business Profile guide covers where posts appear.
Week four: protect the schedule you just filled
The reason this play works is also the reason it can backfire. You will book a cluster of visits into weeks that already have holiday cancellations. Three things keep it from turning into a no-show pile:
- Confirm the day before by text. A one-line reminder with a reply option. "Reply C to confirm or R to reschedule."
- Watch the early and late slots. In our data only 21.4% of the 71,195 practices we track list Saturday hours. If you have them, put FSA patients there first, because weekday evening slots are where December cancellations pile up.
- Answer the phone in the gaps. Year-end callers are often shopping between two practices. An unanswered call goes to the next name on the map. The missed call guide covers text-back, and the calculator shows what a month of missed calls costs at your visit value.
A quick example
Say you have 600 active and recently active patients. You do not know how many have an FSA, and you should not guess. Even if a small slice books one or two extra visits each because of a reminder, those are visits from people who already trust you, booked at no advertising cost, in the weeks that usually sag. Compare that to the cost of a new patient from paid search in the Google Ads guide and the math is not close.
What not to do
Do not discount. FSA patients are spending pre-tax money they would otherwise lose, and a discount just shrinks your fee for no reason. Do not invent urgency either. If your message says money is expiring and the patient's plan has a grace period, you have lost some credibility for January.
And skip a third text. Two texts and a desk conversation are plenty.
If you would rather have the reminder texts and the year-end Google posts handled for you, the free 14-day trial covers any one service with no card. Text or call (385) 213-7449.
Steven has spent the last several years running growth campaigns for local service businesses, chiropractors among them, and builds the benchmark datasets on this site from public Google listings. About the editor