Any health reimbursement insurance experience in the group?

[Guest guest]

I need guidance.

Through my employer, I participate in a health care expense

reimbursement plan.

Money from each pay check is subtracted from each paycheck before

taxes, therefore providing a tax benefit. If I don't use all the money

subtracted over the course of a calendar year, they keep the remainder.

The plan is designed to cover medical expenses not covered by standard

health care insurance, like co-pays for prescriptions, for example,

and " legal medical services " as defined by the IRS

This company is refusing to reimburse me for my visit and travel to

Dr. R because he's out of town.

They dispute its " medical necessity, " given all the doctors in

Houston. So I provide must a statement of " medical necessity " that

might change their minds.

As yet, they haven't responded to my questions about who, among all

the people involved in my health care, is qualified to provide that

statement. I'm pretty sure I'm not on the list, though, because

they've also referred to traveling to Dr R as " personal choice. "

Anyone ever tangled with this kind of company? Know anyone who has?

Thanks,

kidbobo

[Guest guest]

That's just hogwash....The company should reimburse you for ANY doctor you choose to see for a Flex Account, regardless of where he/she is. Travel (mileage and parking) is considered a reimbursement expense as well as doctors fees.

I have had trouble in the past with Aetna reimbursing us for tests they consider 'experimental' but never doctors.

They are supposed to even reimburse you for many over the counter meds, like aspirin, ear and eye care, cold medicines first aid supplies, laxatives AND hormones. You need to ask them for a copy of what is reimbursable, but in any event I think there is a list on the IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is very long that clarifies what is and isn't reimbursable. In any event the money is YOURS, not theirs, which I have had to remind Aetna of many times. You should also demand a list from the Flex people. I have one that I got from Aetna.

You also may want to call the IRS to see if they can clarify whether the people that administer the Flex Account even have a right to demand that this is 'medically necessary".

Steph S.> To: Texas_Thyroid_Groups > Date: Sat, 17 Jan 2009 16:07:03 +0000> Subject: Any health reimbursement insurance experience in the group?> > I need guidance.> > Through my employer, I participate in a health care expense> reimbursement plan.> > Money from each pay check is subtracted from each paycheck before> taxes, therefore providing a tax benefit. If I don't use all the money> subtracted over the course of a calendar year, they keep the remainder.> > The plan is designed to cover medical expenses not covered by standard> health care insurance, like co-pays for prescriptions, for example,> and "legal medical services" as defined by the IRS> > This company is refusing to reimburse me for my visit and travel to> Dr. R because he's out of town. > > They dispute its "medical necessity," given all the doctors in> Houston. So I provide must a statement of "medical necessity" that> might change their minds.> > As yet, they haven't responded to my questions about who, among all> the people involved in my health care, is qualified to provide that> statement. I'm pretty sure I'm not on the list, though, because> they've also referred to traveling to Dr R as "personal choice."> > Anyone ever tangled with this kind of company? Know anyone who has?> > Thanks,> kidbobo> > > > > ------------------------------------> >

[Guest guest]

We have the same thing. We only have to

submit everything to our insurance and that it was denied. Then we get

reimbursed.

Are you trying to get reimbursement for

hotel, mileage things other than the office visit and labs?

Kim

From: Texas_Thyroid_Groups [mailto:Texas_Thyroid_Groups ] On Behalf Of Bobo Amerigo

Sent: Saturday, January 17, 2009

10:07 AM

To: Texas_Thyroid_Groups

Subject:

Any health reimbursement insurance experience in the group?

This company is refusing to reimburse me for my visit

and travel to

Dr. R because he's out of town.

They dispute its " medical necessity, " given all the doctors in

Houston. So I

provide must a statement of " medical necessity " that

might change their minds.

Anyone ever tangled with this kind of company? Know anyone who has?

Thanks,

kidbobo

[Guest guest]

Who is the company? It was my understanding that they had to reimburse

it. You might see if it is a billing code issue. Look up all the rules

that the government has put into place. They should pay back for the Dr

apt, labs and x-ray, those are all normal medical expenses. Where you go

and what doctor is NOT their business. You out on the travel, they won't

cover that.

Kate G

At 10:07 AM 1/17/2009, you wrote:

>I need guidance.

>

>Through my employer, I participate in a health care expense

>reimbursement plan.

[Guest guest]

I'm requesting reimbursement for the labs, visit, and air fare. My

Blue Cross insurance doesn't include payment for any out-of-network

docs until I've spent $5000.

The IRS document includes air fare as a legitimate medical expense.

But the company is applying geographical restrictions from a document

that they are not sharing with me.

Sorry you have the same issue. I'm perusing the Texas Insurance Board

and the IRS websites to see what I may find. Certainly, I'll share

anything info or help that I find.

Thanks, Kim.

>

> We have the same thing. We only have to submit everything to our

insurance

> and that it was denied. Then we get reimbursed.

>

>

>

> Are you trying to get reimbursement for hotel, mileage things other

than the

> office visit and labs?

>

>

>

> Kim

>

>

>

> _____

>

> From: Texas_Thyroid_Groups

> [mailto:Texas_Thyroid_Groups ] On Behalf Of Bobo Amerigo

> Sent: Saturday, January 17, 2009 10:07 AM

> To: Texas_Thyroid_Groups

> Subject: Any health reimbursement insurance

> experience in the group?

>

>

>

> This company is refusing to reimburse me for my visit and travel to

> Dr. R because he's out of town.

>

> They dispute its " medical necessity, " given all the doctors in

> Houston. So I provide must a statement of " medical necessity " that

> might change their minds.

>

> Anyone ever tangled with this kind of company? Know anyone who has?

>

> Thanks,

> kidbobo

>

[Guest guest]

Up until 2008, I had NO problems at all getting my $s from my FSA.

However, 2008 was a nightmare - they denied oodles, including the

OTC stuff they're supposed to cover. I included ANYTHING and

EVERYTHING they might need. They claimed they couldn't interpret

receipts, even though stores like Target label FSA items. I have

spent hours on the phone with those folks and they tell me they'll

follow-up and they never do. I have read the IRS rules and I know

that I am only submitting allowable expenses. I have not even tried

to get travel expenses.

So, this year, I'm sticking to claiming only Rxes, the amounts I

have to pay not covered by insurance (sending them the EOBs) and

using my card only at places that are part of the system - that was

something new last year. In the past, I could use it everywhere,

including docs that weren't in network. I have stopped using it

for my copays as these folks don't seem to understand the concept

and can't seem to interpret line items - i.e., if the total isn't

matching what you're claiming, they'll deny it. For this year, as

well, I am creating a spreadsheet to track all my health related

expenses and see where I am in terms of the cutoff for being able to

deduct them. Even the difference in price between GF food and non-GF

can be claimed. Given what my teens consume these days, I really

think I might hit that percent (it's 7-8% as I recall).

Given all the corporate downsizing, I can't get anyone in my HR dept

to care one bit. And, the battle to not pay the full price for Rxes

that MUST be name brand is never ending.

I have Cigna and there are also a few tests they won't cover -

fortunately, it's not been too many. Although at this time, I still

have 3 other claims to follow up on - they've only paid one even

though I sent them in separate envelopes with separate claim forms.

But, overall Cigna has been pretty good - they cover almost all my

labs when done through Quest, Labcorp or CPL.

Here again, it's us that pay the price for the quality of healthcare

in the US. - the insurance companies hang onto our dollars unless we

make a big fuss.

I recently met a lady that worked in the insurance industry and

helped to develop the CPT codes. IT's a nightmare (and ripoff) how

they determine what's the " going price " for particular procedures,

etc. AND, she said that 50% of all claims are denied - that's their

objective and that less than half the people follow-up. In the past

when I had Aetna, I spent tons of time fighting with them over

claims. They finally got to the point where they were doing it

right, but it makes me wonder if they don't tag certain accts as

being folks that will follow-up and those that don't. AGain, the

folks that aren't as assertive pay the price.

B.

>

>

> That's just hogwash....The company should reimburse you for ANY

doctor you choose to see for a Flex Account, regardless of where

he/she is. Travel (mileage and parking) is considered a

reimbursement expense as well as doctors fees.

>

> I have had trouble in the past with Aetna reimbursing us for tests

they consider 'experimental' but never doctors.

>

> They are supposed to even reimburse you for many over the counter

meds, like aspirin, ear and eye care, cold medicines first aid

supplies, laxatives AND hormones. You need to ask them for a copy of

what is reimbursable, but in any event I think there is a list on

the IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is

very long that clarifies what is and isn't reimbursable. In any

event the money is YOURS, not theirs, which I have had to remind

Aetna of many times. You should also demand a list from the Flex

people. I have one that I got from Aetna.

>

> You also may want to call the IRS to see if they can clarify

whether the people that administer the Flex Account even have a

right to demand that this is 'medically necessary " .

>

> http://windowslive.com/explore?

ocid=TXT_TAGLM_WL_t1_allup_explore_012009

>

[Guest guest]

I couldn't agree more.

Thank you so much for the IRS reference. Did you know there's the name

and phone number of an actual IRS person on a press release associated

with it? Wow.

Thank you

>

>

> That's just hogwash....The company should reimburse you for ANY

doctor you choose to see for a Flex Account, regardless of where

he/she is. Travel (mileage and parking) is considered a reimbursement

expense as well as doctors fees.

>

> I have had trouble in the past with Aetna reimbursing us for tests

they consider 'experimental' but never doctors.

>

> They are supposed to even reimburse you for many over the counter

meds, like aspirin, ear and eye care, cold medicines first aid

supplies, laxatives AND hormones. You need to ask them for a copy of

what is reimbursable, but in any event I think there is a list on the

IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is very long

that clarifies what is and isn't reimbursable. In any event the money

is YOURS, not theirs, which I have had to remind Aetna of many times.

You should also demand a list from the Flex people. I have one that I

got from Aetna.

>

> You also may want to call the IRS to see if they can clarify whether

the people that administer the Flex Account even have a right to

demand that this is 'medically necessary " .

>

> http://windowslive.com/explore?ocid=TXT_TAGLM_WL_t1_allup_explore_012009

>

[Guest guest]

To reach a live person at the IRS, who should then be able to put you

in touch with the expert in this area:

Dial 1- during regular business hours.

Choose option 2 the first TWO times from the automated menu.

After you enter your social security number, they will give you 8 or 9

choices.

DO NOT select an option but just WAIT.

A live person will come on the line.

Marti

> I couldn't agree more.

>

> Thank you so much for the IRS reference. Did you know there's the name

> and phone number of an actual IRS person on a press release associated

> with it? Wow.

>

> Thank you

[Guest guest]

Thanks, Marti.

>

> > I couldn't agree more.

> >

> > Thank you so much for the IRS reference. Did you know there's the name

> > and phone number of an actual IRS person on a press release associated

> > with it? Wow.

> >

> > Thank you

>

[Guest guest]

It was called FlexCorp, but it appears that they were purchased by

BPAH (http://www.bpah.com/index_flex.htm).

I was told that the governing document was IRS publication 502,

Medical and Dental Expenses, which says (on page 12), under Medical

Services:

You can include in medical expenses amounts you pay for legal medical

services provided by:

-physicians

-surgeons

-specialists, or

-other medical practitioners

It also says (page 14), under Transportation:

You can include in medical expenses amounts paid for

transportation primarily for, and essential to, medical care.

You can include:

- Bus, taxi, train, or plane fares or ambulance service,

Also on page 14, under Trips:

You can include in medical expenses amounts you pay for

transportation to another city if the trip is primarily for, and

essential to, receiving medical services. You may be able

to include up to $50 per night for lodging.

(I'm not requesting reimbursement for lodging. I go out and back on

the same day.)

Yesterday, they added a document with a number similar to a document I

saw mentioned on the IRS website. So, I have to poke around there some

more.

I agree that why I went is none of their business. It makes me so

angry. It's taken me decades to find the right treatment. This kind of

claptrap feels like a slap in the face.

Thanks for letting me vent,

kidbobo

> >I need guidance.

> >

> >Through my employer, I participate in a health care expense

> >reimbursement plan.

>

[Guest guest]

But the law is still the law, and do they want to go to court. They think

they have most people over a barrel, but there is a very big uprising out

here because Americans are sick and tired of being *blanked* over and are

beginning to take more steps t'wd these criminals (yes criminals) in the

courts.

Re: Any health reimbursement insurance

experience in the group?

> Up until 2008, I had NO problems at all getting my $s from my FSA.

> However, 2008 was a nightmare - they denied oodles, including the

> OTC stuff they're supposed to cover. I included ANYTHING and

> EVERYTHING they might need. They claimed they couldn't interpret

> receipts, even though stores like Target label FSA items. I have

> spent hours on the phone with those folks and they tell me they'll

> follow-up and they never do. I have read the IRS rules and I know

> that I am only submitting allowable expenses. I have not even tried

> to get travel expenses.

>

> So, this year, I'm sticking to claiming only Rxes, the amounts I

> have to pay not covered by insurance (sending them the EOBs) and

> using my card only at places that are part of the system - that was

> something new last year. In the past, I could use it everywhere,

> including docs that weren't in network. I have stopped using it

> for my copays as these folks don't seem to understand the concept

> and can't seem to interpret line items - i.e., if the total isn't

> matching what you're claiming, they'll deny it. For this year, as

> well, I am creating a spreadsheet to track all my health related

> expenses and see where I am in terms of the cutoff for being able to

> deduct them. Even the difference in price between GF food and non-GF

> can be claimed. Given what my teens consume these days, I really

> think I might hit that percent (it's 7-8% as I recall).

>

> Given all the corporate downsizing, I can't get anyone in my HR dept

> to care one bit. And, the battle to not pay the full price for Rxes

> that MUST be name brand is never ending.

>

> I have Cigna and there are also a few tests they won't cover -

> fortunately, it's not been too many. Although at this time, I still

> have 3 other claims to follow up on - they've only paid one even

> though I sent them in separate envelopes with separate claim forms.

> But, overall Cigna has been pretty good - they cover almost all my

> labs when done through Quest, Labcorp or CPL.

>

> Here again, it's us that pay the price for the quality of healthcare

> in the US. - the insurance companies hang onto our dollars unless we

> make a big fuss.

>

> I recently met a lady that worked in the insurance industry and

> helped to develop the CPT codes. IT's a nightmare (and ripoff) how

> they determine what's the " going price " for particular procedures,

> etc. AND, she said that 50% of all claims are denied - that's their

> objective and that less than half the people follow-up. In the past

> when I had Aetna, I spent tons of time fighting with them over

> claims. They finally got to the point where they were doing it

> right, but it makes me wonder if they don't tag certain accts as

> being folks that will follow-up and those that don't. AGain, the

> folks that aren't as assertive pay the price.

>

> B.

>

>

>>

>>

>> That's just hogwash....The company should reimburse you for ANY

> doctor you choose to see for a Flex Account, regardless of where

> he/she is. Travel (mileage and parking) is considered a

> reimbursement expense as well as doctors fees.

>>

>> I have had trouble in the past with Aetna reimbursing us for tests

> they consider 'experimental' but never doctors.

>>

>> They are supposed to even reimburse you for many over the counter

> meds, like aspirin, ear and eye care, cold medicines first aid

> supplies, laxatives AND hormones. You need to ask them for a copy of

> what is reimbursable, but in any event I think there is a list on

> the IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is

> very long that clarifies what is and isn't reimbursable. In any

> event the money is YOURS, not theirs, which I have had to remind

> Aetna of many times. You should also demand a list from the Flex

> people. I have one that I got from Aetna.

>>

>> You also may want to call the IRS to see if they can clarify

> whether the people that administer the Flex Account even have a

> right to demand that this is 'medically necessary " .

[Guest guest]

If I understand the IRS documents correctly, health reimbursement

accounts are funded by one's employer.

So, if I end up in small claims court, am I suing my employer?

geez louise

> >>

> >>

> >> That's just hogwash....The company should reimburse you for ANY

> > doctor you choose to see for a Flex Account, regardless of where

> > he/she is. Travel (mileage and parking) is considered a

> > reimbursement expense as well as doctors fees.

> >>

> >> I have had trouble in the past with Aetna reimbursing us for tests

> > they consider 'experimental' but never doctors.

> >>

> >> They are supposed to even reimburse you for many over the counter

> > meds, like aspirin, ear and eye care, cold medicines first aid

> > supplies, laxatives AND hormones. You need to ask them for a copy of

> > what is reimbursable, but in any event I think there is a list on

> > the IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is

> > very long that clarifies what is and isn't reimbursable. In any

> > event the money is YOURS, not theirs, which I have had to remind

> > Aetna of many times. You should also demand a list from the Flex

> > people. I have one that I got from Aetna.

> >>

> >> You also may want to call the IRS to see if they can clarify

> > whether the people that administer the Flex Account even have a

> > right to demand that this is 'medically necessary " .

>

[Guest guest]

Not if your employer is funding the account with YOUR pre-tax dollars...

Marti

> If I understand the IRS documents correctly, health reimbursement

> accounts are funded by one's employer.

>

> So, if I end up in small claims court, am I suing my employer?

>

> geez louise

>

>

>>>>

>>>>

>>>> That's just hogwash....The company should reimburse you for ANY

>>> doctor you choose to see for a Flex Account, regardless of where

>>> he/she is. Travel (mileage and parking) is considered a

>>> reimbursement expense as well as doctors fees.

>>>>

>>>> I have had trouble in the past with Aetna reimbursing us for tests

>>> they consider 'experimental' but never doctors.

>>>>

>>>> They are supposed to even reimburse you for many over the counter

>>> meds, like aspirin, ear and eye care, cold medicines first aid

>>> supplies, laxatives AND hormones. You need to ask them for a copy of

>>> what is reimbursable, but in any event I think there is a list on

>>> the IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is

>>> very long that clarifies what is and isn't reimbursable. In any

>>> event the money is YOURS, not theirs, which I have had to remind

>>> Aetna of many times. You should also demand a list from the Flex

>>> people. I have one that I got from Aetna.

>>>>

>>>> You also may want to call the IRS to see if they can clarify

>>> whether the people that administer the Flex Account even have a

>>> right to demand that this is 'medically necessary " .

>>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Have you involved your HR person with the problem?

Kate G

At 05:40 PM 1/18/2009, you wrote:

>Not if your employer is funding the account with YOUR pre-tax dollars...

>

>Marti

>

>

>

> > If I understand the IRS documents correctly, health reimbursement

> > accounts are funded by one's employer.

> >

> > So, if I end up in small claims court, am I suing my employer?

> >

> > geez louise

> >

> >

> >>>>

> >>>>

> >>>> That's just hogwash....The company should reimburse you for ANY

> >>> doctor you choose to see for a Flex Account, regardless of where

> >>> he/she is. Travel (mileage and parking) is considered a

> >>> reimbursement expense as well as doctors fees.

> >>>>

> >>>> I have had trouble in the past with Aetna reimbursing us for tests

> >>> they consider 'experimental' but never doctors.

> >>>>

> >>>> They are supposed to even reimburse you for many over the counter

> >>> meds, like aspirin, ear and eye care, cold medicines first aid

> >>> supplies, laxatives AND hormones. You need to ask them for a copy of

> >>> what is reimbursable, but in any event I think there is a list on

> >>> the IRS site (IRS Rev. Rul. 2003-102, September 3, 2003) that is

> >>> very long that clarifies what is and isn't reimbursable. In any

> >>> event the money is YOURS, not theirs, which I have had to remind

> >>> Aetna of many times. You should also demand a list from the Flex

> >>> people. I have one that I got from Aetna.

> >>>>

> >>>> You also may want to call the IRS to see if they can clarify

> >>> whether the people that administer the Flex Account even have a

> >>> right to demand that this is 'medically necessary " .

> >>

> >

> >

> >

> > ------------------------------------

> >

> >