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Flexible spending account

Let’s get your FSA claim approved

Get your FSA claim paid faster. Review the samples below to make sure the documents you’re submitting include all required information.

1-minute read

With documents like these, your claim would be approved

All required details should be included:

  1. Name of provider
  2. Name of patient (who received the item/service)
  3. Description of service
  4. Date of service (not date payment was made)
  5. Amount charged (not amount paid as this could differ from amount charged for eligible service/item)
This document includes all required information.
This document includes all required information.

The examples above would be approved sine they include all required information for claim approval, including: (1) name of the provider, (2) who received the service, (3) description of service, (4) date of service, (5) and cost.

With documents like these, your claim would be denied

Some of the required details are missing. Here are some quick tips:

  • Make sure the date is the date of service, not the date payment was made.
  • If the claim is for a range of dates (7 weeks, for example), the document must show detail for each week.
  • Double-check that the name of the person who received the service is included, not the name of the account holder, unless it is the same person.
  • Please remember amount paid is not equal to amount charged. The document must show amount charged for the eligible service/item. Amount charged (not amount paid as this could differ from amount charged for eligible service/item).
This document does not indicate which items are FSA eligible. A letter of medical necessity from a provider would also be required to approve the claim.

This document does not indicate which items are FSA eligible. A letter of medical necessity from a provider would also be required to approve the claim.

This document is missing name of patient, description of service, date of service and amount charged for eligible item/service.

This document is missing name of patient, description of service, date of service and amount charged for eligible item/service.

This document is missing date of service (cannot be handwritten), description of service and amount charged (we only process off of amount owed, not paid amount).

This document is missing date of service (cannot be handwritten), description of service and amount charged (we only process off of amount owed, not paid amount).

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