Claim denied: Now what?

If you file a claim and it is denied, you’ll need to provide proof that the product or service was for a medically necessary reason. The first step is to submit a new receipt and complete the Request for More Information form, which will be sent to you. Then note the following steps and timing, according to how you submitted the claim.

Manual/online claim:

  1. Within 10 days of receiving the denial letter, complete and return a Medical Necessity Form, which can be found on the member website: “Tools & Support” > “Account Support & Forms.” If the reason is approved, your claim will be processed and paid.
  2. If you do not return the form within 10 days, your claim will be marked overdue, and you’ll have 30 days to return it or your claim will be denied.

Debit card

  1. Within 10 days of receiving the denial letter, complete and return the Medical Necessity Form, which can be found on the member website: “Tools & Support” > “Account Support & Forms.” Your claim status will be updated to “received.”
  2. If you do not return the form within 10 days, you’ll receive a Final Debit Card Receipt Request, and you’ll have another 10 days to complete the request, and your status will be updated to “received.”
  3. If you still do not complete the request, you’ll receive a Denial with Repayment Request, and use of funds from the impacted account will be suspended for 30 days.