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Very Timely Question about Flexible Spending. NEED TODAY PLS



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amother
Dodgerblue


 

Post Tue, Dec 19 2017, 10:58 am
Can you use your flexible spending account to pay for out of network medical expenses that you may get partially reimbursed for from your insurance?

So lets say you go to a medical specialist out of network and pay 200. can you submit that? Say at a later date, your health insurance approves the out of network claim and reimburses you for $100 as per your plan. is it ok that you paid the full amount from your flex spending acct?
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Cookiegirl




 
 
    
 

Post Tue, Dec 19 2017, 11:21 am
You can use your FSA money to pay for out of network services. With regard to the partial reimbursement, I am not an expert at this, and I haven't researched this particular question, but I believe that the correct thing to do in this scenario would be to put the money that was reimbursed by insurance back into your flex account. I don't know whether companies have a true mechanism for tracking this, however. Generally for the FSA to approve the payment, they do ask for certain documentation (including the Explanation of Benefits from your insurance company). So, if it were completely Out of Network and non-reimbursible, your EOB would so state. Similarly, the partial reimbursement would show on the EOB, and then you would likely get a letter from the FSA instructing you to pay back your employer.
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amother
Tangerine


 

Post Tue, Dec 19 2017, 11:23 am
amother wrote:
Can you use your flexible spending account to pay for out of network medical expenses that you may get partially reimbursed for from your insurance?

So lets say you go to a medical specialist out of network and pay 200. can you submit that? Say at a later date, your health insurance approves the out of network claim and reimburses you for $100 as per your plan. is it ok that you paid the full amount from your flex spending acct?


AIUI, you can be reimbursed for $100 out of flexible spending, and the other $100 out of insurance. You cannot be reimbursed more than your out of pocket.
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amother
Lawngreen


 

Post Tue, Dec 19 2017, 11:25 am
My FSA is linked to my health insurance, and I get reimbursed automatically based on EOBs. Out of network services are definitely included.
IME, if a claim is resubmitted, the system doesn't realize and they don't request any money back or take it out of the next item that is reimbursed. I have to confess that I never went through the hassle of trying to notify them because I generally go over my FSA limits in any case. (So in your example, I got an extra $100, but then later in the year $200 more of copays weren't reimbursed because I finished my FSA account. I should technically return the "extra" $100 and then get it back for the other copays, but I never bothered.)
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amother
Dodgerblue


 

Post Tue, Dec 19 2017, 11:26 am
So what happens if I don't know if I will get reimbursed? can I submit for the entire amount? what if the reimbursement only happens a year later after all the rejections, appeals, etc with health insurance?
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1091




 
 
    
 

Post Tue, Dec 19 2017, 11:37 am
amother wrote:
So what happens if I don't know if I will get reimbursed? can I submit for the entire amount? what if the reimbursement only happens a year later after all the rejections, appeals, etc with health insurance?


generally FSA won't reimburse you without an EOB from the insurance company.
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