There are a handful of denial reasons to be aware of:
Claim amount & receipt amount mismatch - the amount you're requesting to be reimbursed for does not match the payment amount on your receipt
Claim date & receipt date mismatch - the date of expense and date on your receipt does not match
Claim outside of plan year - the expense was made outside of the benefit plan year
Receipt is missing/invalid - the claim did not include a valid receipt
Ineligible expense - the expense type/items are not eligible in the benefit program
Other - the reason will be specified by your employer or plan administrator
Most denial reasons can easily be remediated by submitting a new and corrected claim. For some denials, you can discuss the decision with your employer or plan administrator and submit an appeal as necessary.
Appealing a decision
All appeals, with the exception of Dependent Care FSA appeals, must be communicated by email and submitted to the form linked below within 180 days of the original decision.
Important: Dependent Care FSA claim appeals must be communicated and sent within 60 days of the original decision.
What happens next?
Once an appeal is received, an appropriate, named plan fiduciary who did not make the initial decision and who is not a subordinate of the individual who made the initial decision will review and decide on the appeal.
Decisions on appeals will be sent within 30 days. If special circumstances require more time to reach a decision, it will be made as soon as possible, but not later than 120 days after receiving the request.
Here's what to take note of:
The review will show no deference to the initial decision.
Customer or authorized representative may submit written comments, documents, records, or other information relating to the claim for benefits, and, upon request and free of charge, will be provided reasonable access to, and copies of, all documents, records, and other information relevant to the claim for benefits.
Customers may request the identity of any medical experts consulted by the plan in connection with the initial benefits decision.
The plan fiduciary who considers the appeal will take into account all information submitted, regardless of whether it was submitted or considered in the initial decision.
If the appeal is related to clinical matters, the review will be done in consultation with a healthcare professional with appropriate expertise in the field who was not involved in the prior determination.
The Plan Administrator may consult with, or seek the participation of, medical experts as part of the appeal resolution process.