December FSA Spend-Down: What Your Bills and EOBs Will Actually Reimburse

# December FSA Spend-Down: What Your Bills and EOBs Will Actually Reimburse Every December, a predictable thing happens: people with an expiring FSA balance go shopping. And a lot of that shopping is unnecessary, because the reimbursable expenses were already sitting in a pile of unopened mail. Before you buy anything, check what you already owe. ## Use the right number The single most common reason a claim comes back rejected is submitting the wrong figure off the paperwork. A medical bill and its EOB carry at least four numbers: - **Billed charge** — what the provider asked for. Frequently several times the real cost. Not your number. - **Allowed amount** — the negotiated rate the plan and provider agreed on. - **Plan paid** — the insurer's share. - **Patient responsibility** — what is left for you. **Patient responsibility is the reimbursable amount.** On an EOB it is often labelled "you may be billed." Submit the billed charge and you are asking to be reimbursed for money nobody is going to collect. ## "Incurred," not "paid" For a health FSA, the expense has to be **incurred** during the plan year — meaning the *care was provided* in that window. Whether you have paid the provider yet is a separate question. That cuts two ways, and both are useful in December: - A bill for care you received in **November is reimbursable**, even if you are still paying it off in March. - **Prepaying in December** for a procedure scheduled in February is **not** reimbursable against this year's balance. The care has not happened. ## Where the money usually is If you are hunting for reimbursable expenses, look here before you look at a shopping cart: **Already incurred, probably in a drawer** - Copays and coinsurance from visits earlier in the year - Amounts applied to your deductible - Dental work — cleanings, fillings, crowns, orthodontia - Therapy and mental health care - Chiropractic and physical therapy - Prescriptions, including refills you paid cash for **Genuinely useful, and eligible** - Eye exams, prescription glasses and sunglasses, a year of contact lenses - Over-the-counter medicine — eligible without a prescription since the CARES Act - Sunscreen SPF 15+, first aid supplies, menstrual products - Medical devices: blood pressure monitors, thermometers, braces, CPAP supplies, hearing aids Durable equipment deserves a specific mention. If you have a large balance and no pending bills, a blood pressure monitor or a hearing aid is a better use of the money than a drawer full of things you will not open. ## What gets denied **Health insurance premiums.** Unmistakably a medical cost, and categorically not reimbursable from a health FSA. This one catches people every year. **Everyday toiletries.** Shampoo, toothpaste, soap, deodorant, makeup. **Cosmetic procedures**, unless they correct a deformity arising from a congenital abnormality, injury or disease. ## The middle category: get the letter first Vitamins and supplements, gym memberships, and weight-loss programs are **dual-purpose** — they can be medical or they can be ordinary living, depending on why you are buying them. They become reimbursable with a **letter of medical necessity**: a short note from a licensed provider naming the diagnosed condition, the item or service recommended, and the expected duration of treatment. Get it **before** you submit the claim. Chasing a letter after a denial, in the last week of December, is a bad plan. Two exceptions worth knowing: prenatal vitamins are eligible without a letter, and a weight-loss program prescribed to treat a diagnosed disease such as obesity or hypertension qualifies where a general wellness program does not. ## Two deadlines, not one Your plan has a **spending deadline** — the last day to incur an expense — and a **claim deadline**, the last day to submit paperwork for expenses already incurred. They are different dates, and the claim deadline is usually later. Which means: if the care happened before the spending deadline, you have not missed anything yet. Find the bills and file. ## Do it faster Paste your line items into the free [FSA and HSA eligibility checker](https://medicalbillparser.com/tools/fsa-eligible-expenses) and it sorts them into reimbursable, needs-a-letter, and will-be-denied, with totals against the balance you are trying to clear. If you are not sure what that balance is, the [FSA forfeiture calculator](https://paystubparser.com/tools/fsa-deadline-planner) works it out from your pay stub. *General information, not tax or benefits advice. Your plan administrator has the final say on any specific claim; IRS Publication 502 governs what counts as a medical expense.*