I have an HSA as of this year but have a medical bill coming up that will exceed the current amount paid in. With my FSA. The account would pay out basically going negative until more payments into it covered the balance. Does this also happen with HSA and using that payment card?
Cheers

I don't know the answer, but I had a similar bill recently and I got them to split the bill - I paid what I could with the HSA money and paid the rest out of my pocket.

Did you get the amount you paid out of pocket refunded once sufficient balance in HSA?

To some extent, it will depend on the way the HSA account is run. However, there is no requirement to claim the bill from the account immediately that it's incurred.

This actually does go to extremes - if you can afford it, the most cost-effective way to use an HSA is to pay the medical bills with normal cash, let the account grow, store the bills for years or even decades, and then claim for all bills much later. This allows the HSA contributions, growth and payments to all be tax-free. The potential disadvantages are: 1. the risk of losing all the bills, and 2. the hassle to your heirs of claiming for them if you die before claiming.

I always paid out of my own pocket in the early days when the funds available were not sufficient.
I know that I could have paid myself back when the HSA was more healthy, but did not. My aim being to keep the funds there and build them up to a decent amount so as to avoid the situation again.

Are all funds the same regardless of the bank they are held with? Will it be listed in the T&C of the account?

HSA cannot go negative.

An HSA is your own personal account and can't go negative. An FSA, otoh, isn't really your "property" per se. Not only can it go negative -meaning that your employer, temporarily at least, picks up the tab, but you may forfeit balances under the "use it or lose it" provisions.

I still haven't built up sufficient balance yet, I don't even know if I can anyway. My HSA company charges big one-off fees for doing anything other than personally paying by card, I think it is about $20 to get a cheque from them.

I'm upping my contributions this year, amazing how one event can eat it all up. I stupidly kept it low because I thought people might have attempted to improve the US healthcare system by now and it would become pointless.
Ha!

I have an HSA debit card.

Rene