We know that having your Medical Expenses declined can be frustrating. But not to fear, you are able to check the reason for the decline. More often than not we are in need of more information. If you have a medical expense claim that was declined, you can find more details by clicking into the claim itself to see an explanation for why the claim was declined. All information from our compliance team concerning why the claim was declined will be available in your member portal, so before reading on, you should check in your portal first! You will see a reason in the red alert box for why it was declined and if we need additional information from you to re-submit it.
If your Medical Expense is eligible, you will be able to resubmit your Expense for review by creating a new submission using the 'add monthly premium' button on the Dashboard of your portal.
There are a few common reasons that medical expense claims are declined for reimbursement through QSEHRA and ICHRA:
The expense claim was submitted for your monthly insurance premium, rather than a one-time medical expense. You do not need to submit an expense claim for your monthly premium. Once we have approved it through your onboarding process, we will have your premium amount set in our system, and we will apply that amount automatically to your reimbursement amount in your employer's monthly report.
The date of service for your expense was before the HRA start date. According to the IRS, a medical expense can only reimburse if the date of service happened after the start of the HRA, rather than the date of the invoice.
The expense is not eligible for reimbursement, according to IRS publication 502. The IRS has some guidelines on expenses that can and cannot be reimbursed through your HRA. Find out more here.
The expense is from the previous calendar year, and we are over 90 days into the new calendar year. According to IRS regulations, employees have up to 90 days after the beginning of a new calendar/plan year to submit claims from the previous calendar/plan year.
Your document did not upload. There may not be a document there for our compliance team to review!
Your document is missing the date of service. The document does not show the date of service. According to IRS guidance, claims are eligible based on the date of service rather than the date billed or date paid.
As a reminder, the requirements for expense documentation to be approved as follows:
· Patient name
· Medical provider / hospital / pharmacy name
· Date of service
· Specific services provided
· Cost of service
Below we are linking a website that shows all of the reimbursable items. Look for the menu option on the left-hand side, then at the bottom it will show a list of eligible medical expenses. Once there, filter by HRA and you should be able to see it! FSAstore.com Eligibility List (https://fsastore.com/fsa-eligibility-list)
If you're still unsure, please feel free to reach out for further explanation. We are always happy to help!