Reimbursement and Exception Requests
Reimbursement Requests
Via Benefits processes reimbursement requests according to the terms of the plan document and IRS rules. If an expense is denied, the specific reasons for the denial are provided in the Explanation of Unpaid Expenses (EOUE).
An expense in a “not approved” status can often be resolved through the submission of additional documentation to meet the plan rules. Contact us to discuss any additional options if you feel you've submitted all required documentation, and your concern isn't resolved.
An expense in a “denied” status means the expense doesn't meet the plan rules for reimbursement, such as being an eligible expense or being submitted for reimbursement within the submission deadline. One of our representatives can review your account to determine if there’s any action available to resolve the denial. An exception request may be needed for a denied expense when the plan document rules weren't met, and there are extenuating circumstances that could explain why the request should be approved.
Exception Requests
Contact us to request an exception over the phone or in writing. Be prepared to provide proof of your extenuating circumstance. Some employers require all requests for exception be submitted as a written appeal. A Via Benefits representative can provide you with these instructions. Please be aware not all former employers or benefits providers allow for exceptions or appeals.
Appeal Requests
You may submit an appeal to ask for additional review. An appeal can’t be accepted over the phone. All appeal requests must be written and sent by mail. Send your appeal request, along with a statement that explains the reason for the appeal, to the address provided on your Reimbursement Request Form or other communication. You must file the appeal within 180 days of the date you received notice of the action in concern. A written appeal needs to be as complete as possible and contain the following information to improve processing.
Including the EOUE, or other supporting documents, with the appeal is helpful in identifying the person and issue in question.+
Account holder name+
Account holder Social Security number or last 4 digits of SSN and ZIP Code
Expense number+
Expense amount+
Dates of service (start and end dates)+
Covered person’s name (if different from account holder)
Expense description+
Employer name+
Date of the denial or change in status+
Reason for denial or change in status
A statement that explains the reason for the appeal
The statement needs to indicate why you feel the expense should be covered, or why funding should be provided, reinstated, or the amount reviewed. Include any information that would help substantiate or determine if the appeal can be approved.
Supporting documents that may include additional expense details, a Letter of Medical Necessity, proof of extenuating circumstance, or a request for an exception to the plan rules.
You'll receive a written communication of the appeal decision within 30 days of receipt. If your appeal is denied, the communication provides information on next steps.
*Via Benefits reimbursement accounts are administered by Extend Health, LLC.