There are several reasons a claim can be denied or partially approved. (See "Understanding claim denials" for the common ones.)
Know why it was denied? Fix it and resubmit
If you know what needs to change, or want to add additional documentation, you don't need to appeal. You can submit a new claim instead, for the full amount if it was fully denied, or just the amount that wasn't approved if it was partially denied.
Filing a formal appeal
You can formally appeal a denied or partially approved claim in writing. Review your plan rules to confirm your appeal meets any deadlines set in your plan documents. Your plan administrator will review your appeal within their designated timeline and notify you of the outcome.
Before you appeal, reach out to support
Contacting the support team first can often resolve questions about your specific decision faster than a formal appeal.
Claim appeal deadlines
Benefit Account Type | Deadline to Appeal | Administrator’s Deadline to Respond |
Commuter | Consult plan documents | Within 60 days |
DC-FSA | Consult plan documents | Within 60 days |
FSA | 180 days after you received notice of denial | Within 60 days |
HRA | 180 days after you received notice of denial | Within 60 days |
ICHRA | 180 days after you received notice of denial | Within 60 days |
LP-FSA | 180 days after you received notice of denial | Within 60 days |
LSA | Consult plan documents | Within 60 days |
Other benefit deadlines
For benefits without deadlines listed, please consult your plan documents. All benefits have a shared deadline of 60 days for the administrator to respond.