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Thread: FSAFEDS Appeals anyone?

  1. #13

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    Default Re: FSAFEDS Appeals anyone?

    Quote Originally Posted by alevin View Post
    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!

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  3. #14

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    Default Re: FSAFEDS Appeals anyone?

    Quote Originally Posted by crws View Post
    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.
    "life can only be understood backwards, but it must be lived forwards" - soren kierkegaard

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  5. #15

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    Default Re: FSAFEDS Appeals anyone?

    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.

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  7. #16

    Default Re: FSAFEDS Appeals anyone?

    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 .

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  9. #17

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    Default Re: FSAFEDS Appeals anyone?

    Ohh...Good point. Bet so.

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  11. #18

    Default Re: FSAFEDS Appeals anyone?

    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?


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  13. #19

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    Default Re: FSAFEDS Appeals anyone?

    Quote Originally Posted by Scout333 View Post
    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.

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  15. #20

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    Default Re: FSAFEDS Appeals anyone?

    Quote Originally Posted by fabijo View Post
    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

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  17. #21

    Default Re: FSAFEDS Appeals anyone?

    James, Seems I heard a rumor that the maximum amount allowable under the FSAFEDs plan is being reduced. Do you know by how much and when this will kick in?

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  19. #22

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    Default Re: FSAFEDS Appeals anyone?

    Quote Originally Posted by Scout333 View Post
    James, Seems I heard a rumor that the maximum amount allowable under the FSAFEDs plan is being reduced. Do you know by how much and when this will kick in?
    That is an item specifically addressed on the website I just gave the URL for. It's in 2013. The amount is $2,500.

    That, and more information, is on the http://www.kff.org/healthreform/8060.cfm website.

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  21. #23

    Default Re: FSAFEDS Appeals anyone?

    Thanks James, I asked before I looked at the link.

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