With a completed Claim for Reimbursement Form, it is important to send the proper documentation to substantiate your claim. The Internal Revenue Service requires that the documentation include:

• Service provider information to include name, address and phone number
• Patient information to include name, address and phone number
• Date of service
• Description of service or item
• Charges or patient responsibility

Itemized Patient Statements from service providers and Explanation of Benefits (EOB’s) from insurance carriers are perfect forms of documentation. You do not need to show proof of payment.

Dual-purpose items such as massage therapy, membership to a weight loss program, over-the-counter medicines, vitamins, herbs or supplements, require a medical practitioner’s referral that includes the diagnosis of the specific medical condition for which it is prescribed. We require a copy of that referral each time you request reimbursement for that item. Over-the-counter medications, vitamins, minerals and supplements used for general health are not eligible for reimbursement.