FAQ
For flexible spending accounts (FSAs) and health reimbursement arrangements (HRAs), the IRS requires account administrators (such as Optum Financial) to verify funds are being spent on qualified medical expenses. This is known as “substantiating” a claim.
As much as possible, we automatically verify transactions without requiring additional documentation. This is called “auto-substantiation”.
When we are unable to auto-substantiate a claim, the IRS requires that we request additional documentation from you to verify the expense as eligible.
For more information, reference Publication 969 or Publication 502 at irs.gov.
Documentation must be from a third-party, such as a retailer or provider, and show the following:
Who: The name of the person who received the product or service (not required for cash register receipts that provide all other details)
What: A description of the product or service. Example: Wellness visit, dental cleaning, RX, first aid kit, over the counter medications and other qualified medical expenses
When: The date of service. This may be different than the date you paid for the service
Where: The provider or retailer name
How much: The amount you paid/amount you are responsible for
Examples of documentation include an itemized statement, receipt or explanation of benefits (EOB). Find examples of documentation that will help get your claim approved quickly, by selecting your account type above.
You will be notified via letter or email from Optum Financial. You will also see messages when you sign in to your Optum Financial online account or mobile app (status will say, “Paid, documents needed”). The claims page also shows reimbursement requests for required receipts.
If documentation or repayment is not provided for an ineligible transaction, your payment card will be shut off and any future reimbursement requests will be used to repay your account. If, at the end of the plan year, the transaction has not been resolved, the amount(s) may be added to your taxable income by your employer. For more information, please review your plan documents provided by your benefits team or internal benefits resources.
Please see your plan documents provided by your benefits team or internal benefits resources for details.
There are two other options:
1. Reimburse your account by sending a check or money order with the claim number in the memo field, payable to:
Repayment Department
PO Box 871095
Kansas City, MO 64187-1095
2. Submit a new claim that has not been reimbursed as a substitute and we will deduct the ineligible amount from the new claim. See How to Submit a Claim
A service or expense must be incurred before it is eligible for reimbursement. An expense is considered “incurred” when the service is performed, not when you pay for the service. The service also must be performed during your participation in the plan. Services or expenses incurred before or after your plan participation dates do not qualify for reimbursement.
If you use your payment card and the expense is deemed ineligible after the expense is already paid, you will be required to reimburse your account for that transaction. If you fail to reimburse the account, you may be required to pay income taxes. If you file a manual request for reimbursement of a non-eligible expense, the request will be denied.
If the amount you request for reimbursement is more than your available balance, you will be reimbursed up to the amount available in your account.
An EOB is typically provided by your insurance company, for claims processed through insurance or for copays. It shows all required information (name of patient, description of service, date of service, name of provider, cost of item/service) to get your claim approved quickly.
If your claim is processed through insurance or for copays, an EOB is typically provided by your insurance company. An EOB shows all required information (name of patient, description of service, date of service, name of provider/retailer, cost of item/service) to get your claim approved quickly.
If you feel your claim was denied in error, you may appeal this decision. Your appeal must be sent in writing to:
Optum Financial Claims Department
12921 S Vista Station Blvd
Draper, UT 84020
Your appeal must be sent no later than 180 days after your claim was denied. It will be reviewed, and a determination will be made by Optum Financial within 60 days of receipt. A letter will be sent to you with the final decision.