Have a denied claim? Here's some information that might be useful!
Common reasons for claim denials
Common reasons for claim denials include:
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 do not match
Claim outside of plan year - the expense was made outside of the benefit plan year
A 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
Resubmitting a corrected claim
Most reasons for denial can easily be remediated by submitting a new and corrected claim.
Contacting support
If you need additional information about your claim denial before making a formal appeal, contact Support within the appeal deadline timelines listed below.
Formal appeal deadlines
You also have the right to formally appeal a denied claim in writing.
Benefit Account Type | Deadline to Appeal | Administrator’s Deadline to Respond |
Commuter | 60 days after you received notice of denial | Within 60 days |
DC-FSA | 60 days after you received notice of denial | 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 |
LPFSA | 180 days after you received notice of denial | Within 60 days |
LSA | 60 days after you received notice of denial | Within 60 days |
How to submit a formal appeal
You may request a formal appeal in writing by following these steps:
Submit your appeal request to support using the attached form. You must send your appeal request within the deadline to appeal the timeline listed above.
Your plan administrator will review your appeal request within their designated timeline and notify you of the outcome of your appeal.
Here are some insights into the formal appeal process.
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 appeal will consider all information submitted, regardless of whether it was submitted or considered in the initial decision.
The plan administrator may consult with, or seek the participation of, medical experts as part of the appeal resolution process.