Submitting a claim through your Health Spending Account (HSA) or Wellness Spending Account (WSA) should be a straightforward process, and it is our goal to make sure your claims get approved and reimbursed to you, but there are some reasons why claims might have to be denied. If our adjudicators do have to deny a claim, they'll always let you know by adding a note to the claim, which notifies you via email as well. You can view the notes by going to your "View Claims" tab and clicking the "View" button beside the denied claim.
Understanding these reasons can help you avoid issues and ensure your claims are processed smoothly.
1. Not Enough Information
One of the most frequent reasons for claim denial is the lack of sufficient information. To process your claim, the following details are typically required:
Detailed Receipts: Receipts should include the date of service, the provider’s name and credentials, a description of the services or items provided, the patient name, and the amount paid.
Proof of Payment: Evidence that the payment was made, such as a credit card statement or bank transaction record.
Additional Documentation: Sometimes additional documentation, such as a doctor's referral or prescription, is required to substantiate the claim.
2. Not an Eligible Service or Item
Claims can also be denied if the service or item is not eligible under your plan. Common ineligible items include:
Cosmetic Procedures: Procedures that are purely cosmetic and do not have a medical benefit are not eligible under an HSA.
Over-the-Counter Medications: Unless prescribed by a doctor and dispensed by the pharmacist with an "Official Prescription Receipt", over-the-counter medications are not eligible.
Non-Medical Services: Services not related to medical care, such as elective treatments that aren't done by a medical practitioner.
3. Ineligible Practitioner
Claims for services provided by practitioners who are not recognized or licensed may also be denied. Ensure that:
Licensed Practitioners: The service provider is licensed and recognized by the appropriate regulatory body.
Covered Professionals: The professional is included in the list of eligible providers under your HSA
4. Name on Receipt Doesn’t Match Name on Profile
Another common issue is when the name on the receipt does not match the name on the profile. This can happen in cases where:
Aliases or Nicknames: The receipt uses an alias or nickname instead of the legal name on the HSA profile. If this is the case, update your name in your profile to include both your legal name, and your nickname or alias in brackets next to it. For example "Charles (Chuckie) Smith"
Dependents: Claims that show a service or item purchased for a family member who is not on the account. To add a dependent, go to your settings tab and enter the dependent information. Always ensure dependents are eligible on your plan by checking your plan details on your dashboard.
To avoid this issue, ensure that the name on the receipt matches the name on your myHSA profile, and properly indicate if the claim is for a dependent (select their name from the dropdown once you have added them!)
5. Claim is Inputted for the Incorrect Benefit Year
Claims must be submitted for the correct benefit year. If the service date falls outside the current benefit year or if the service date does not have a balance, the claim may be denied.
Service Date: Ensure that the service date on the receipt matches the service date you enter on the claim information, this will ensure you have a balance to apply to it, as the system will stop you from submitting if you don't.
Available Balance: Check that there is an available balance for the benefit year in which the service was provided on your dashboard!
Tips for Avoiding Claim Denials
Double-Check Documentation: Before submitting a claim, verify that all necessary information and documentation are included.
Understand Your Plan: Familiarize yourself with the specific rules and eligible expenses under your myHSA plan.
Keep Records: Maintain detailed records of all receipts and documentation related to your claims.
Verify Provider Eligibility: Confirm that the service provider is licensed and eligible under your plan.
Match Names Correctly: Ensure the name on the receipt matches the name on your profile or correctly indicate if the claim is for a dependent.
If you have any questions or need assistance, contact myHSA support by emailing support@getmyhsa.com or opening a live chat!