If you've had a claim denied that seems similar to one that was approved in the past, there could be a few reasons for this. Here are some common explanations:
Past Claim Approved in Error: Occasionally, human error can occur in the adjudication process. A claim that was previously approved may have been processed incorrectly. While we strive for accuracy, this is a risk that comes with having human adjudicators review claims.
Receipt Format May Be Different: Even small changes in the format of a receipt can affect whether a claim is approved. Ensure that your receipt contains all the necessary information, such as the provider’s name, patients name, date of service, and itemized details.
CRA Guidelines May Have Changed: The Canada Revenue Agency (CRA) updates its guidelines periodically, and a claim that was once eligible may no longer meet the current standards. Check your list of covered items for updates.
Employer Plan Design May Have Changed: It's also possible that your employer has made changes to your benefits plan, which could impact the eligibility of certain claims.
Check the Claim Notes: To find out the exact reason for your claim denial, head to the "View Claims" tab in your account. There, you’ll see notes from the adjudicator explaining why the claim was denied.
Think There’s Been an Error?: If you feel your claim was denied in error or you need further clarification, don’t hesitate to reach out. Email us at adjudicator@getmyhsa.com and we’ll be happy to assist you!