Can I use HSA funds for diastasis recti surgery? Considered elective but medically related

This is incredibly helpful! I hadn't thought about getting a specific Letter of Medical Necessity. His primary care doctor has documented the condition, but we don't have anything explicitly stating it's medically necessary. Would the letter need to come from his PCP or would the surgeon's assessment work too? Also, if we do get this documentation and use HSA funds, how likely is this to trigger an audit? I'm nervous about making a mistake here.

Either doctor can provide the Letter of Medical Necessity, but ideally both would document it. The surgeon is probably more familiar with writing these letters specifically for diastasis recti repair. Make sure the letter clearly states the functional/physical purpose of the surgery rather than any cosmetic benefits. As for audit risk, HSA distributions aren't automatically flagged more than other deductions, but you should always keep all documentation indefinitely. The letter, medical records showing the diagnosis, and all receipts should be saved. In my experience, having proper documentation from the beginning means there's little to worry about even if questions arise later.

That's interesting! How long did it take to get an answer back from them? And did you end up successfully using your HSA for the dental work? I'm dealing with an insurance denial for orthopedic surgery they're calling "experimental" but my doctor says is standard care.

Did they help with any documentation you could use if you got audited? My biggest concern with these gray areas is having enough backup if the IRS questions it later.

I got my answer in less than 24 hours! And yes, I successfully used my HSA funds for the dental implants with no issues. The documentation guidance was really clear about what I needed from my dentist. They provided a detailed report I could keep for my records specifically addressing the tax code provisions that supported my case. It included citations to relevant IRS publications and tax court cases where similar expenses were allowed. That's actually what impressed me most - it wasn't just general advice but specific documentation I could use if ever questioned.

Wait, how does this actually work? The IRS specifically told me they don't take calls about medical expenses and HSA questions. Did you actually get someone who could help with this specific issue?

Sounds too good to be true honestly. I've tried calling the IRS so many times about tax questions and either get disconnected or wait for hours only to get someone who can't help. They expect us to understand their vague publications but won't answer specific questions. How would this service be any different?

They use a system that navigates the IRS phone tree and holds your place in line, then calls you once an agent is ready to talk. I was connected to someone in the tax law department who definitely answered my HSA questions. The agent couldn't tell me "yes, your specific procedure qualifies" because they don't give that kind of binding advice over the phone, but they explained exactly what documentation I would need and the specific section of the tax code that covers medical expenses. They pointed me to IRS Publication 969 and explained how they interpret "medical necessity" versus what insurance companies consider necessary. Completely different from the automated recording I kept getting before.

This is so helpful to hear from someone who's been through the exact situation! Did you get a specific Letter of Medical Necessity or just use the regular medical documentation from appointments? And did you consult with a tax professional before making the HSA withdrawal?

We got a formal Letter of Medical Necessity from both doctors - it was different from standard medical notes. We specifically asked for letters that addressed IRS requirements for medical necessity. Our surgeon was familiar with writing these for insurance denials and knew exactly what to include. We did consult with our accountant before making the withdrawal, and she advised us on exactly what documentation to collect. She mentioned that having clear documentation of the functional issues being addressed was crucial. One thing our doctor included was that without repair, my wife was at higher risk for hernia and back problems in the future - focusing on prevention of future medical issues rather than just current discomfort. That preventative angle apparently strengthens the case significantly for IRS purposes.

Just be careful with this advice. Publication 502 is specifically for medical expense deductions on Schedule A, not HSA withdrawals. While there's significant overlap, they're technically governed by different sections of the tax code. For HSA withdrawals, Publication 969 is the primary source, though it does reference the definition in 502.

You're right about the different publications, but the definition of qualified medical expenses is the same for both purposes. Publication 969 specifically states: "A qualified medical expense for HSA purposes is generally one that would qualify for the medical and dental expenses deduction" and then directs you to Publication 502. So while they are different tax benefits, they use the same definition of qualified medical expenses. The IRS website confirms this: qualified medical expenses for HSA purposes are defined by the same section 213(d) that applies to itemized deductions. That's why Publication 502 is still the right place to look for the detailed list of what qualifies.

Thank you for sharing your experience! It's so reassuring to hear from someone who successfully navigated this exact situation. Your point about insurance denial not automatically disqualifying HSA use is really important - I think a lot of people (myself included) assume they have to match. The specific details you mentioned about documenting functional limitations are really helpful. I'm going to make sure our doctors focus on those practical impacts rather than just the medical diagnosis. Did you have any concerns about the IRS questioning the withdrawal later, or did having the proper documentation give you confidence it would hold up? Also, did your doctors charge extra for writing the Letters of Medical Necessity, or was that included as part of their regular care?

This is such great advice about keeping detailed records of the actual payments! I hadn't thought about the IRS potentially wanting to verify that HSA withdrawals were actually used for the stated medical expense rather than just withdrawn and spent on something else. Your point about documenting the timeline is really smart too. In our case, my husband's condition developed after his significant weight loss, so we have a clear progression from when it first became noticeable to when conservative approaches (physical therapy, targeted exercises) weren't providing sufficient improvement. Having that documented medical journey should help establish that surgery became the logical next step rather than an immediate choice. I'm curious - are you planning to get your Letters of Medical Necessity before scheduling the surgery, or after? I'm wondering if it's better to have that documentation in place before we commit to the procedure date, just to be completely sure we can justify the HSA withdrawal.

This is incredibly detailed and practical advice - thank you! As someone new to navigating HSA rules, the specific terminology recommendations are really valuable. I wouldn't have thought about the importance of using precise medical language like "functional impairment" versus more general descriptions. Your point about the 85-pound weight loss actually strengthening the case is reassuring. It helps frame this as a medical consequence of significant body changes rather than an elective procedure, which seems important for IRS purposes. I'm curious about the before/after photos suggestion - would those need to be taken by the medical provider, or could we document the condition ourselves? And should we be asking our surgeon specifically about this during our consultation, or is it something most surgeons automatically include in their records for these types of procedures? Also, since you work in medical billing, do you have any insights on timing? Should we get all this documentation lined up before scheduling the surgery, or is it typical to get the Letters of Medical Necessity after the procedure is already planned but before it's performed?

The photos should definitely be taken by medical staff as part of your official medical records - patient-taken photos won't carry the same weight with the IRS. Most surgeons who regularly do diastasis recti repairs are familiar with this documentation requirement, but it's worth specifically asking during your consultation. Regarding timing, I always recommend getting the Letters of Medical Necessity before scheduling surgery. Here's why: if for some reason the documentation doesn't support HSA qualification as strongly as you hoped, you'll want to know that before committing to the procedure date and potentially scrambling to find alternative funding. The ideal timeline is: 1) Get letters from both your PCP and surgeon stating medical necessity, 2) Review those letters to ensure they use the right terminology and address functional impacts, 3) Schedule the surgery with confidence that your HSA withdrawal will be justified. Also, make sure both letters specifically mention that this is repair of muscle separation resulting from significant weight loss. That medical context is crucial - it shows this isn't cosmetic enhancement but correction of a structural problem caused by dramatic body changes. The IRS tends to view procedures more favorably when there's a clear medical cause like pregnancy, weight loss, or injury rather than general aging or appearance preferences. One last tip: keep copies of everything related to your husband's weight loss journey too - medical records showing his starting weight, any physician-supervised weight loss programs, documentation of the timeline. This creates a complete medical narrative that supports the necessity of the repair.