FSAFEDS Appeals anyone?

[alevin]

You know, I've had Flex Savings Account for past few years, never had a problem with them.

I thought I was going to have a couple minor surgeries last year, so put extra in the 2009 account, but never got around to getting the surgeries.

One problem finally healed on its own by year end (had a year of low-key pain that always threatened to elevate if I did something wrong-but I just couldn't force myself to schedule the surgery-hand. major part of my job is computer work-one handed? ugh.).

The other potential surgery I deferred, helps me get a sinus infection every year til I get it fixed.

So ANNNyway I had a slush fund at the start of 2010 that I wanted to spend down, so I did-expensive prescription bifocals and things like that. Charges all incurred between Jan 1 and 3/15 (last date to incur reimbursible eligible expenses against the 2009 account).

I didn't renew the Flex Savings account for 2010, since I had so much left over in the 09 account to use up.

My health insurance company didn't forward my copays to FSAFEDS after the new year, even tho I expected them to. I had signed up for paperless for 2009 account. Took me awhile to realize I was going to have to submit claims myself for everything between Jan and March 15 2010 (grace period).

So I submitted 2009 account grace period claims by April 30 (due date). Today I got denials for everything. The rationale? I don't have an account. Looks like they are ignoring fact I have 2009 account that could incur expenditures through grace period of 3/15/10.

I'm going to have to do the appeals thing-all the way up to the highest "court" if need be. They must not do quality control on their newest claims review employees until somebody starts throwing things at the fan-which I'll be doing immedjitly.

Anyone else run into this kind of situation with them? If so, how'd it turn out? I'm doing the slow burn right now. Good thing I don't have to take blood pressure pills-yet. :suspicious: Grrrrrr.

 

[burrocrat]

i don't have much to offer here except for a bird in the hand is worth two in the bush, careful who you give hamburgers to today under promise to pay on tuesday.

seriously, i don't advance plan like that and i avoid the doctors except for threatening emergencies, been like once in the last 5 years, they might check me in take a good look strap me to a gurney and not let me out. if i'm vertical and can walk and it don't hurt too bad then i'm good to go.

me: dr. it hurts when i do that ...

them: then don't do that ... that'll be 100 bucks.

 

[Scout333]

You know, I've had Flex Savings Account for past few years, never had a problem with them.

I thought I was going to have a couple minor surgeries last year, so put extra in the 2009 account, but never got around to getting the surgeries.

One problem finally healed on its own by year end (had a year of low-key pain that always threatened to elevate if I did something wrong-but I just couldn't force myself to schedule the surgery-hand. major part of my job is computer work-one handed? ugh.).

The other potential surgery I deferred, helps me get a sinus infection every year til I get it fixed.

So ANNNyway I had a slush fund at the start of 2010 that I wanted to spend down, so I did-expensive prescription bifocals and things like that. Charges all incurred between Jan 1 and 3/15 (last date to incur reimbursible eligible expenses against the 2009 account).

I didn't renew the Flex Savings account for 2010, since I had so much left over in the 09 account to use up.

My health insurance company didn't forward my copays to FSAFEDS after the new year, even tho I expected them to. I had signed up for paperless for 2009 account. Took me awhile to realize I was going to have to submit claims myself for everything between Jan and March 15 2010 (grace period).

So I submitted 2009 account grace period claims by April 30 (due date). Today I got denials for everything. The rationale? I don't have an account. Looks like they are ignoring fact I have 2009 account that could incur expenditures through grace period of 3/15/10.

I'm going to have to do the appeals thing-all the way up to the highest "court" if need be. They must not do quality control on their newest claims review employees until somebody starts throwing things at the fan-which I'll be doing immedjitly.

Anyone else run into this kind of situation with them? If so, how'd it turn out? I'm doing the slow burn right now. Good thing I don't have to take blood pressure pills-yet. :suspicious: Grrrrrr.

Have you talked with a real live person Yet? May be simple to fix, this can't be the first time this has happened. Good luck! Keep the pressure down.

 

[Scout333]

Alevin, Saw this info on the FSAFED site. Hope it helps.

What is the FSAFEDS Grace Period?
The grace period is an additional 2 ½ months (January 1 through March 15) during which you can incur eligible expenses that can be reimbursed from your prior year balance. The grace period helps accountholders avoid forfeiting any of the funds they deposited in FSA accounts. It does not mean you can have prior year expenses paid from the current year. To learn more, visit the FSAFEDS Video Library and watch the "Grace Period" video.

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How will eligible grace period expenses be reimbursed?
First, you must have a remaining balance as of December 31. If you do not have a balance, the grace period will have no affect on your account.
If you have a balance as of December 31 and you incur eligible expenses during the grace period (January 1 thru March 15)simply submit those expenses in the same manner as you normally would by using the FSAFEDS Health Care claim form or FSAFEDS Dependent Care claim form.

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Do I have to have a 2010 account to take advantage of the grace period?
No. Since the grace period is a part of the 2009 Benefit Period, you do not need to have a 2010 account to take advantage. You must be employed by an agency that participates in FSAFEDS and be actively making allotments from your pay through December 31 in order to participate in the grace period. If you separate or retire from the government after December 31, you will still be eligible for the grace period after you leave.

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I enrolled in a general purpose HCFSA in 2009 but will enroll in an HSA in 2010. I know that means I can only enroll in the LEX HCFSA, but how does that work with the grace period?
Your grace period claims (those incurred between January 1 and March 15) can include expenses eligible under a general purpose HCFSA but those claims have to be paid from your 2009 account. General purpose HCFSA eligible expenses (that are not dental or vision related) cannot be paid from your 2010 LEX HCFSA.

In addition, if you had a general purpose HCFSA in 2009 and you switch to an HDHP with an HSA for 2010, your HSA funding will be postponed until April 1.

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How are grace period claims paid if I do not have a current year account?
If you do not have a current year account, grace period claims will be paid directly from your previous year account, up to the available balance. You cannot take advantage of the grace period if your employment status changes (you separate from Federal service or transfer to a Federal agency that is not covered by FSAFEDS) on or before December 31.

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What if I have an overpayment on my prior year account?
If you have an overpayment on your prior year account, we will apply your grace period expenses towards the overpayment to offset the amount.

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How will grace period expenses be handled if I have paperless reimbursement?
If you are enrolled in paperless reimbursement, grace period expenses will be paid from your current year account, up to the available balance.

 

[alevin]

I reviewed the appeals process last night. I only saw the denial message at end of day yesterday. Talking to a live person (informal appeal) will be my first level of appeal-when I get the chance. Headed out of town early today for rest of the week, away from computers, away from phones. Good thing, it will help me get the blood pressure back down before I try talking to live person.

next week is first chance I'll get to do the first-level appeal.

 

[Scout333]

I reviewed the appeals process last night. I only saw the denial message at end of day yesterday. Talking to a live person (informal appeal) will be my first level of appeal-when I get the chance. Headed out of town early today for rest of the week, away from computers, away from phones. Good thing, it will help me get the blood pressure back down before I try talking to live person.

next week is first chance I'll get to do the first-level appeal.

Hello Alevin, Any luck with the FSA appeal? How did that work out?

 

[alevin]

I've been gearing up mentally for having the "informal appeal" conversation. Been buried in urgent work issues that needed to get quieter. Plan on making the phone call today.

Most of the items they denied were because they said I didn't have an account (which I don't-this year). Their excuse is irrelevant and bogus. I was using my 09 $ during the grace period first quarter this year, when those funds were still useable. They don't even know their own **** rules. Those items I will absolutely appeal to the highest court.

Some of the OTC things they denied because I didn't send in the "boxtops", even tho the rules also say you can send in the register receipts if the item is clearly identified on the receipt (item should be circled on the receipt-which I did). I may lose on that one, who knows? I'll appeal it to the next level anyway.

But it's a heads up for those of you who send in the receipts instead of the "boxtops"-they'll use that as an excuse for denial, and you may have to fight it (and get them to read and abide by their own *** written rules).

 

[XL-entLady]

Good luck, Allie! I had to appeal several times while I had an account. It's YOUR flippin ' money. Don't let them get away with anything. It is frustrating when we have to know the rules better than they do but that's the way it is!

Hang in there!

 

[Scout333]

Some of the OTC things they denied because I didn't send in the "boxtops", even tho the rules also say you can send in the register receipts if the item is clearly identified on the receipt (item should be circled on the receipt-which I did). I may lose on that one, who knows? I'll appeal it to the next level anyway.

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Alevin, Most of the pharmacies mark the items which qualify as Flex items with an F beside them on the receipt. Don't see why that wouldn't suffice. They just don't know who they're dealing with! Good luck.

 

[alevin]

Hah! It was WAAAY more than just OTC expenses. It was purchase of expensive glasses, and a few doctor bills that the insurance company never forwarded to FSAFEDs this winter/spring also.

I was finally in the right frame of mind to make the phone call just now. It took no more than 2 minutes for the guy on the other end to see that they had screwed up. He said he's forwarding my claims to the auditors to get things corrected and me paid back from MY money. We'll see how thorough the auditors are, but I think I'm looking at at least an 80% success rate in resolving things here.

If I don't get full satisfaction, I'll elevate the remainder to next level. Went way better than I expected-so far. Rest of the story remains to be told-will tell the tale as it unfolds.

 

[alevin]

Update time. The FSAFEDS auditors are more competent than the normal reviewers, thank goodness. I received notice today that all my disputed (appealed) claims have been paid as of today. Enough to pay for 2 of the tubular skylights that are getting installed with the new roof starting tomorrow. Yippee yi ki yay.

The fight was well worth it-and they are paying up based on the paperwork I had already submitted, no extra effort on my part, whatta ya know? the "system" worked, for once, I had been sceptical about the appeals process. Glad they have it, wish it wasn't necessary. How much extra did it cost them to not process properly in the first place?

 

[crws]

so that was thru United Healthcare, right?

 

[XL-entLady]

Update time. The FSAFEDS auditors are more competent than the normal reviewers, thank goodness. I received notice today that all my disputed (appealed) claims have been paid as of today.

So congratulations are in order again!

I never had an appeal denied once I elevated it to the auditor level. It was just so frustrating to have to do that when I knew I was right. And I was just trying to get MY money.

Congrats again, and good luck with the roofing work!

 

[alevin]

so that was thru United Healthcare, right?

No, FSAFEDS is not an insurance plan in the FEHB multiple-choice system. I have BC/BS for my insurance.

FSAFEDS is the federal flex-savings account plan, where you decide if you want to put $ aside from your paychecks pre-tax, separarate from your health insurance premiums. You estimate how much out-of-pocket you might pay in a given year and decide to tuck that much away in your account for reimbursement through the year.

Those flex-funds (your money-held in a trust account by FSAFEDS) will reimburse you costs that your insurance plan DOESN't pay-like your deductibles and co-pays, alternative medicine providers, some over the counter things like reading glasses, non-prescription meds (OTC), mileage for out-of-town doctoring, things like that. Your insurance company will normally submit the claims paperwork to FSAFEDS so they can pay what insurance does not.

For things like OTC or mileage, or if insurance forgets to pass along a claim,, you have to submit the claim direct to FSAFEDS to get your $ back-which is what I did.

If you don't spend as much out of pocket by end of the year as you estimated, they get to keep whatever you didn't get spent. Remember, you still set it all aside pre-tax, so whatever you get reimbursed is pretax $ back in your pocket and doesnt get taxed on the backend either.

 

[crws]

Hmmm...
Our postal FSA is administered by United Healthcare. We get a Visa for the FSA qualified stuff, and others we have to submit claims for.
They love to hug the fine line and keep your money in their account, but our medical expenses handily exceed my deduction on a regular basis, so what they reject just gets reimbursed on the next claim submission.
We swamped 'em this year, way ahead of schedule- both my wife & I had numerous visits to the dentist, starting in February.
Don't know about you, but we get mailers starting in October, seems like every other week thru open season, preaching FSA enrollment. So many, in fact, that we discussed it at work last year, and came to the conclusion that there must be a lot of profit at stake for somebody other than us workin' folk to justify such an aggressive ad campaign.
This is our second go round, as we signed up a few years back, but after haggling repeatedly with UHC over FSA claims, we dropped it for a while. The best thing (and clincher) for us in signing up again was the Visa, and although the USPS/UHC FSA program doesn't support Visa payments to Doctors or Medical professionals like some Fed plans, it was very convenient to pay for all our prescriptions and general healthcare items without having to file a claim.

 

[Scout333]

crws, I believe that the pre-tax treatment applies to FICA withholding as well as Federal Income tax withholding on the employee side. Wouldn't that give Uncle a break on the employer side of the FICA for all the FERS folks out there? 7.65% times the FSAFED elected amount? I am pretty sure it works that way for private industry with similar type plans. Company I used to work for had one of these plans .

 

[crws]

Ohh...Good point. Bet so.

 

[fabijo]

This is not quite on the appeals process, but ... Has anybody noticed the change in FSAFeds that says we will now need a prescription for OTC drugs to qualify as an expense?

 

[alevin]

crws, I believe that the pre-tax treatment applies to FICA withholding as well as Federal Income tax withholding on the employee side. Wouldn't that give Uncle a break on the employer side of the FICA for all the FERS folks out there? 7.65% times the FSAFED elected amount? I am pretty sure it works that way for private industry with similar type plans. Company I used to work for had one of these plans .

You know, Scout, I suspected something like this had to be true, but didn't know how to figure it out, even staring at my pay statement. Yes, there is a definite profit incentive for the FSAFEDS people-it's likely they get some kind of base pay for the service. They certainly get to keep any of the FSA withholdings that people don't spend before the deadline and also get to keep anythng that is denied and not appealed and refunded to the appellant.

FAb, I didn't notice the part about needing prescription for OTC, since I didn't sign up this year. wonder how that's working for people-routine things like sunscreen and aspirin, eh? Talk about racking up the pressure on already swamped GP time.

 

[James48843]

This is not quite on the appeals process, but ... Has anybody noticed the change in FSAFeds that says we will now need a prescription for OTC drugs to qualify as an expense?

That kicks in on January 1, 2011, and is part of the health care reform law. It really has nothing to do with FSAFeds- it's in the law. Part of the financing of health care reform is that items that are tax free will have to be prescribed as medically necessary in the future- not just OTC drugs, etc.

See the "Tax Changes" section for 2011 on this summary of Health Reform law changes:
http://www.kff.org/healthreform/8060.cfm