what I would say is happening is your insurance company is substantiating your HSA spend against your actual insurance claims
Outside of years where paying all my medical expenses from taxable income would be inconvenient, my general approach is to contribute the max and let it sit. Given that you're almost guaranteed to spend the money eventually it's basically an extra IRA without income limits.
Did you write a check against the account? Because there's still that verifiable, easily substantiated audit trail. I did specifically talk about cash transactions.
If these are actual medical procedures why wouldn't you just use the card or ACH transactions?
Well you can't contribute to an HSA without a high deductible health plan, and when switching plans almost everyone rolls their existing HSA into the new plan HSA because it's just way easier to manage. Its entirely possible to not do that and have an existing HSA that is no longer tied to a health plan but that is not the norm (and you can't contribute to that particular HSA anymore). So by and large your insurance company has access to all your HSA spend data and obviously has access to your insurance claim data so it's very easy for them to substantiate.
It's perfectly fine to reimburse yourself from your HSA for qualified medical expenses. You don't have to explicitly have transactions out of the HSA with a card at a medical office or anything like that. Just keep your receipts!
What??
For me, I am free to open my HSA anywhere I want, and it's not associated with my BCBS health insurance plan at all. I host my HSA at Fidelity. BCBS has none of the details on my HSA, has no idea if I have one or not, or anything else. Is this really not the norm? I've never met anyone with a HSA that is tied to their health insurance plan. Maybe this is state dependent?
Well you can't contribute to an HSA without a high deductible health plan
I do.
Have mine with work, has a rollover limit. None of your HSAs have a rollover limit?
No, and I've never heard of that.
Sure you aren't talking about a FSA?