Flexible Spending Account (FSA) Unsubstantiated Claims Process

When you receive notices from Optum, the Flexible Spending Account (FSA) Administrator, about unsubstantiated health care claims, substantiate, substitute, or repay your unsubstantiated claims (preferably by December 31st). This page includes information on how to resolve your claims and a timeline of what will occur if you do not resolve your claims timely.

Basics of Healthcare FSA Unsubstantiated Claims

If a health care FSA payment card transaction is not automatically substantiated, you will be notified of an “unsubstantiated claim” that needs to be resolved by substantiation, substitution, or repayment. You will receive notices about the unsubstantiated claim via the email address associated with your Optum account:

  • 10 days after the transaction
  • 40 days after the transaction
  • 70 days after the transaction

If your claims are not resolved within 85 days, your payment card will be deactivated (until your claims are resolved). Check the junk folder in your email for these notices. If you do not have an email address associated with your Optum account, the notices will be sent via U.S. Mail.

The FSA administrator sends these notifications for every health care FSA unsubstantiated claim throughout the year.

Resolving Healthcare FSA Unsubstantiated Claims

To avoid the payroll withholding process, 2024 healthcare FSA claims must be resolved prior to December 31, 2024. To resolve a claim, you should do one of the following:

  • Substantiate the original claim with documentation. Documentation may include:
    • Explanation of benefits (EOB) provided by your health or dental insurance carrier (recommended when available)
    • Itemized statement or detailed receipt
  • Substitute the original claim with another eligible expense. A substituted claim cannot be a claim previously submitted, and must be for the 2024 plan year.
  • Repay the amount of the claim directly to Optum. To do so, log into your account, or contact Optum to walk you through this option.

You may submit documentation to resolve your claims using the Optum mobile app or the Optum website.

Communications

If you have unsubstantiated FSA claims, additional communications are sent toward the end of the plan year. Notifications are sent to the email or mailing address associated with your account.

Inactive Employees

If you are no longer an active employee:

  • You are responsible for updating your email and mailing address directly with Optum.
  • If you do not resolve an unsubstantiated claim, it will be converted to business debt.

Questions

For questions on how to resolve a health care FSA unsubstantiated claim, eligible expenses, or the status of a claim, contact Optum at (833) 881-8158 or visit the Optum mobile app or the Optum website.

Updated: 11/19/2024

Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.