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.
Appeal method
Fill out the appeal request form and send share it with your benefit administrator via chat or mail.
Form: https://cdn.prod.website-files.com/68d6b773a218d5c2a32fe308/6aaad9571a669d45f1362c06_Updated%20Formal%20Claim%20Appeal%20Form%20(1).pdf
About the process
You are entitled to a review (appeal) of the claim determination if you have questions or do not agree.
To appeal, you or your authorized representative should submit a request in writing using the form attached. Your request should include the group name (e.g., your employer), your name, your claim ID, and other identifying information shown on the claim details panel, as well as any comments, documents, records and other information you would like to have considered, whether or not submitted in connection with the initial claim.
You may also review documents relevant to your claim. Upon request and free of charge, you may receive reasonable access to and copies of all documents, records, and other information including any internal procedures or any specific rules, guidelines or protocols relied upon or used during the processing of your claim.
If you are appealing an adverse determination for your General Health Flexible Spending Account (FSA), Health Reimbursement Account (HRA), or Limited Flexible Spending Account (LP-FSA), then your written request for review must be filed within 180 days following receipt of the claims decision.
A review will be conducted and you will be notified of the decision within 60 days. Please review your plan documents or contact your plan administrator to confirm the specific appeals process available to you. If you do not agree with the final determination on review, and if your plan is governed by ERISA, you have the right to bring a civil action under Section 502(a). Please refer to your Summary Plan Description, or contact your employer, to confirm the applicability of ERISA to your plan.