Why Was My Claim Denied?
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. If you’re looking for an overview of the appeals process, see Denied Claims.
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
HSA and FSA reimbursement requires that a product be used for the treatment or management of a diagnosed medical condition, not purely for prevention or general wellness. If your administrator determined that the product on your claim is preventive in nature, the claim may be denied even if you have an LMN.
To address this, the LMN needs to clearly connect the product to the treatment of a specific diagnosed condition. If you believe your situation meets this standard, contact Truemed to discuss whether your LMN can be updated to more clearly reflect the medical necessity.
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.
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.
