5 FSA/HSA Mistakes That Get Your Claim Denied (and How to Avoid Them)

If your FSA or HSA reimbursement claim got denied for a fitness expense, it's almost never because the expense wasn't eligible. It's because something in the paperwork was off.

Here are the five most common reasons claims get rejected — and how to fix each one.

Mistake 1: Letter of Medical Necessity Is Too Vague

The single biggest reason. Your LMN says "exercise is recommended" without specifying what kind, for how long, or for what diagnosed condition.

Fix: A compliant LMN names a specific diagnosis (with ICD-10 code), recommends specific treatments (gym membership, personal training, structured program), and lists a duration (typically 12 months).

Mistake 2: Receipt Doesn't Show What Was Bought

A gym receipt that says "MEMBERSHIP DUES" doesn't tell the administrator what you actually got. Some admins reject these on principle.

Fix: Ask your gym for itemized receipts that say "Personal Training Session" or "Health Club Membership for Member [Name]." Or use our free Receipt Generator for trainer/studio receipts.

Mistake 3: LMN Dated After the Expense

The IRS expects the medical recommendation to predate (or at least be contemporaneous with) the expense. A letter dated after you bought the equipment can trigger a denial.

Fix: Get the LMN signed before you start submitting expenses. If you've already paid, ensure the LMN is dated to cover the period.

Mistake 4: Submitting Too Much at Once

Some admins flag large lump-sum claims for additional review. A single claim for $3,000 is more likely to get scrutiny than monthly claims of $250.

Fix: Submit monthly or quarterly. Spreads the review load, less likely to trigger flags.

Mistake 5: Missing Provider Credentials

The LMN needs the physician's name, NPI number, and signature. Missing any of these is a common technical denial.

Fix: Make sure the LMN draft you send your doctor has placeholders for NPI and signature, and that they fill them in.

What to Do When a Claim Is Denied

Don't accept the first denial. Request the specific reason in writing, then submit an appeal with a clarifying note from your physician. Most denials reverse on appeal when the underlying letter is sound.

DoctorNoted's Premium and Pro tiers include denial appeal support — we draft the appeal letter and respond to admin questions on your behalf.

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