Why was my claim only partially reimbursed?

Why wasn't I reimbursed for my entire claim?

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Written by Support
Updated over a week ago

If you have a claim that is only partially reimbursed, in short, it means that you have used up your allowance year-to-date. But don't worry! You will still get reimbursed for the rest.

Let's break it down:

  • Your HRA allowance is an annual benefit which is unlocked on a monthly basis for you to submit reimbursement requests against.

  • When your total reimbursement claims YTD are more than your total available allowance YTD, it will leave a portion of your claims "unreimbursed."

  • Our system will apply each month’s new allowance to the oldest claim first.

  • The “Reimbursed” column represents how much of a claim has been reported on your employer’s monthly, semi-monthly or bi-weekly Reimbursement Statement that we provide them.

  • The sum of the "Reimbursed" column is equal to your allowance YTD, or at least as of the date of your employer's last Reimbursement Statement.

  • We will continue to track your unreimbursed claims over time and continue to apply each month's allowance to them until they are paid in full.

Here are a few examples of times when you may see this happen.

Example #1 - Your premium is larger than your monthly allowance

For this example, let's use the following:

  • Your HRA allowance is $400 per month

  • Your monthly insurance premium is $600 per month

  • You set up your recurring premium claim for $600 per month

In this case, our system will automatically create a $600 claim on  your behalf each month. So in January, it's easy, right? You know January's $400 allowance is applied to your $600 claim for January.

But remember, each new allowance will be applied to the oldest claim first. That means that your February $400 allowance will first be applied to the remaining balance on the January premium claim until it's reimbursed in full.

This doesn't mean that in January, you received $600, and in February you received $200. It just means that YTD, you have been reimbursed or will be reimbursed $800 total, and the $800 was applied to your claims in order of their submission.

If you would like us to update your recurring claim to be equal to your monthly reimbursement so your claims list looks a little "cleaner," reach out to support@takecommandhealth.com or chat with us in the bottom right hand corner, and we'll get it updated!

Example #2 - You submit a large medical bill for reimbursement

Let's take a look at what happens in your account when you submit a medical bill that is larger than your monthly allowance. 

For this example:

  • Your HRA allowance is $400 per month

  • Your HRA went into effect January 1st

In January, you go to the ER and have a $1,000 bill that you submit for reimbursement. As of January, you only have $400 available in reimbursement allowance. We will automatically apply your January $400 allowance to your claim, and we'll report to your employer that you are owed $400. But for the rest of the month, you'll see that it shows only $400 has been reimbursed.

Then in February, another $400 of HRA allowance will get unlocked. Even if you have submitted a new claim, your February allowance of $400 will get applied to the older claim first. So now January & February's $400 allowances are applied to the $1,000 hospital bill. In March the remaining balance of the ER visit will be reimbursed ($200) and the additional medical expense of $132.75 that was approved previously will now be reimbursed with the available funds. 

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