Why Was My Claim Denied? | Truemed Customer Help Center

This article covers the most common specific reasons HSA and FSA reimbursement claims are denied, along with what you can do to fix each situation.

Document issues

Many claim denials come down to documentation that doesn’t meet your administrator’s specific requirements. These are often the most straightforward to resolve.

Doctor or wet signature required

Some administrators deny LMN-based claims on the grounds that the signature must be handwritten rather than electronic. In most cases, this requirement is not supported by U.S. law.

Under the U.S. Electronic Signatures in Global and National Commerce Act (15 U.S. Code § 7001), a signature, contract, or record cannot be denied legal effect, validity, or enforceability solely because it is in electronic form. An LMN does not fall under any of the narrow exceptions to this rule (such as wills).

What we recommend:

Push back with your administrator. Share the information above and ask them to accept the electronic signature as it’s consistent with federal law. If they refuse, ask them to cite the specific source of their handwritten-signature requirement — in most cases, they won’t be able to.
Contact us if you still need help. If your administrator continues to require a handwritten signature, email us at support@truemed.com. We can often provide an updated LMN in the format your administrator requires.

Provider address in a different state

Certain administrators flag claims when the address of the provider who signed the LMN is in a different state than the patient’s address. This doesn’t automatically disqualify your claim, but it can trigger a manual review or outright denial with some plans.

If this is the reason for your denial, contact Truemed. Depending on your administrator’s policy, there may be steps we can take to address this, or we can help you understand what documentation to provide when you appeal.

Nurse Practitioner vs. Medical Doctor

Some administrators only accept Letters of Medical Necessity signed by a Medical Doctor (MD), and will deny claims backed by an LMN from a Nurse Practitioner (NP) or other licensed provider. If your denial cites the provider’s credentials, reach out to Truemed. We can sometimes accommodate a request for an LMN signed by an MD to meet your administrator’s requirements.

Many states have adopted “full practice authority” allowing Nurse Practitioners (NPs) to sign letters of medical necessity. However, some states like Alabama, Mississippi, South Carolina, and Tennessee often require a physician (MD/DO) to sign your LMN. This is already considered within your Truemed flow and those states will always include an MD signature.

Product ineligibility

These denials relate to the product or service itself, either how it was categorized or how the medical necessity was documented.

Prevention not eligible

Some administrators deny a claim because the LMN lists prevention as the reason for the purchase. Prevention is a recognized purpose under federal tax law. Internal Revenue Code Section 213(d)(1)(A) defines eligible medical expenses as amounts paid “for the diagnosis, cure, mitigation, treatment, or prevention of disease.” IRS Publication 502 and the IRS FAQ on medical expenses also confirm that expenses primarily intended to prevent a disease can qualify when they are medically necessary and properly documented.

A preventive LMN still has to be tied to a specific health condition: it documents the condition the purchase is meant to prevent or keep from progressing. Purchases made for general health are not eligible.

What we recommend:

Resubmit your claim with a short note explaining that your LMN aligns with the tax code and IRS guidance, which explicitly include the prevention of disease. Cite IRC Section 213(d), IRS Publication 502, and the IRS FAQ linked above.
Try a different expense category if your administrator’s portal allows it (for example, “Other Medical Expenses”), in case the original category applies a narrower rule.
Contact us if your claim is denied again. Email support@truemed.com with your denial notice and we can help you with next steps.

Diagnosis not applicable

This denial means the diagnosis listed on your LMN doesn’t clearly connect to the product you purchased. For example, a diagnosis focused on one health area may not be sufficient justification for a product in a different category.

In some cases, taking the Truemed qualification survey again can result in a more appropriate diagnosis being linked to your purchase. Contact Truemed to discuss whether a survey retake or an updated LMN would address this denial.

Product denied as an ineligible expense

Some administrators deny a claim because they consider the product a personal-use or general health item rather than a medical expense. This can happen even when you have an LMN. If your purchase is supported by an LMN, you can appeal using the points below.

Publication 502 is not a complete list. IRS Publication 502 describes the types of medical and dental expenses you can deduct on your taxes, which generally also qualify for HSA/FSA reimbursement. It does not list every eligible expense. A product that isn’t named in Publication 502 can still qualify when it is used for a medically necessary reason.

The three IRS conditions. A health purchase used for a medically necessary reason can qualify when:

A Letter of Medical Necessity (LMN) from a healthcare provider shows the expense is needed to treat or prevent a specific health condition.
The expense is primarily for the prevention or treatment of that condition. The LMN should show a clear clinical connection between the condition and the product. For prevention, it should explain how the product helps prevent the condition from developing or progressing.
The condition has been diagnosed by a healthcare provider qualified to make that diagnosis.

Truemed LMNs are issued by independent practitioners licensed in your state and are written to document each of these points.

What we recommend:

File a formal appeal using the process described in your plan documents. Include the points above and explain how the product treats or prevents your diagnosed condition.
Include your LMN and itemized receipt with the appeal. For partially eligible products, also include your LMN addendum showing the eligible amount.
Contact us if you need help. Email support@truemed.com with your denial notice and we can help you with your appeal.

Products missing from claim

If you purchased multiple items in a single transaction but only some of them appear on your claim, or if certain products were left off, you may be able to add them.

How this happens: When a cart contains a mix of eligible and ineligible items, the claim submitted to your administrator may only reflect the items Truemed identified as eligible at the time of your qualification. If you believe an eligible product was left off, contact Truemed with your original order details.

What documentation is needed per product: Each item added to a claim needs to be supported by:

An itemized receipt showing that specific product
Medical necessity documentation (usually the LMN) that connects the product to a diagnosed condition

How to proceed: Email support@truemed.com with your order confirmation, the items you believe should be included, and any denial notice you received. Truemed will review whether the missing products can be added to your documentation and guide you on next steps with your administrator.

Next steps after a denial

Use this decision path to figure out your best next action:

Identify the denial reason — Read your denial notice carefully. Is it a document issue, a product eligibility question, or an administrator-specific policy?
Document issues — Contact Truemed first. In most cases we can update or correct your LMN or other documentation before you re-submit. See Denied Claims for re-submission guidance.
Product ineligibility — Contact Truemed to discuss whether your documentation can be strengthened. If the product genuinely doesn’t meet eligibility requirements, Truemed will be upfront with you about your options.
Administrator-specific denial — Contact Truemed for guidance specific to your administrator. Then file a formal appeal with your administrator within their stated deadline.
Escalate if needed — If your appeal is denied, ask your administrator whether a second-level appeal or independent review is available. For FSA plans, up to three levels of appeal are typically permitted.

For any of these situations, you can reach Truemed at support@truemed.com. Include your denial notice, the denial reason or code, and your administrator’s name so we can give you the most relevant guidance.