Fighting/rectifying a mistake made by FSA admins
June 3, 2013 5:31 PM   Subscribe

Asking for my SO. Short version: Because of incorrect information we received from ADP (our FSA administrators) in February, we're about to lose $1400 in SO's FSA that we had saved for her Lasik. We've contacted a healthcare advocate, and are trying to move up her surgery; in your experience, is there anything else we can do?

Long version:

My SO badly wants Lasik, and we decided the changeover between fiscal years this summer was the time to do it. The total out-of-pocket (to be covered/reimbursed by FSA) is $4400*. We had $2500 (her plan max) deducted from her pay over the past year; $1400 remains. We're now locked into deducting another $2500 this year.

* I know this may be expensive; she's very nearsighted, and is having it done at a highly-rated teaching hospital eye clinic. Ignore the amounts.

She was not enthused about the idea of getting one eye done in June and one in July, which is what she thought would need to happen to use both years' FSA balances. In February she contacted ADP through her account on their website (so they have all of her plan information in the e-mail), and they replied saying explicitly that there was a grace period for spending the previous year's balance, so she could have both eyes done in July, exhausting the previous FY's balance, followed by the current FY.

Today she was working on setting up her appointments, so she called them to ask about something else (using the FSA debit card for some of it rather than paying OOP, I think). The person she spoke to said that the e-mail she received was totally incorrect and that no such grace period exists on her plan. This means that unless we can get one eye done this month (an increasingly unlikely proposition), she will either have to spend the remaining balance on something else (and there is nothing that she needs, or even wants), or she will lose it.

She spoke to a healthcare advocate that works with our insurance plan, who is equally baffled by the terrible miscommunication. I'm worried that since it's a tax issue, that there's no possibility of leniency owing to their mistake. And it's not like it's even a judgement call or he-said-she-said; she has the e-mail (with full headers, IP addresses, etc), and had she not gotten the incorrect information, would have scheduled her surgery (or rather, surgeries) around this restriction.

Does anyone have experience dealing with FSAs over stuff like this? Is there anything else we can do in the meantime other than work with the advocate, or try our damnedest to get one of her eyes done in June?

Worst-case scenario bonus question: Assuming that there's no room for leniency or anything from the FSA, and she can't get one eye done before July, does anyone have brilliant (expensive!) ideas for spending down an FSA (for a young childless female) other than glasses/sunglasses, contacts, contact solution, and contraception?
posted by anonymous to Work & Money (12 answers total) 1 user marked this as a favorite
Can she speak to the clinic about this and prepay for the surgery?
posted by jeather at 5:44 PM on June 3, 2013 [1 favorite]

First step. Get a copy of the actual plan document for the FSA and find out who is telling the truth about the grace period. Grace periods are extremely common so just double check.
posted by magnetsphere at 5:55 PM on June 3, 2013 [1 favorite]

Mod note: From the OP:
Sorry-- should have clarified. There is no grace period. The communication over email was completely incorrect, despite being signed by the benefits center of my SO's employer. However, it stopped her from planning accordingly around this restriction; it actually suggested having both eyes done in July.

Also, it is our understanding (and confirmed by the clinic) that the relevant date is the date of the surgery, so prepaying isn't an option.
posted by jessamyn (staff) at 6:06 PM on June 3, 2013

I had the very same experience. My administrator told me that there was a 90 days grace period in which to use the funds. After I had some expensive dental work and attempted to pay, it was all rejected and I had to pay out of pocket. The grace period they refer to is 90 days to file claims for services rendered during the plan's calendar year.

I was out $1200. Your unused funds at the end of the plan year are returned to your employer. You could try and lobby your HR/Benefits representative to see if they will return the monies to you, but I'm not sure if you will be successful. I was not successful in my efforts.
posted by Jacob G at 6:16 PM on June 3, 2013 [1 favorite]

My guess is that her best bet is to have a reasonable and civil conversation with the clinic administrator and try to get one eye done in June. The front desk folks can't do anything, but the office manager or clinic director might be able to squeeze her in somewhere or at least give her first dibs on cancellations. Doctors have a bit of a rep as oblivious to costs, but if one of my patients explained to me that having something done in June rather than July would save her $1400, I'd work pretty hard to make that happen.
posted by The Elusive Architeuthis at 6:48 PM on June 3, 2013 [1 favorite]

Agree to try to take it up the food chain at the doctor's office.

Hmm, in terms of spending, can you spend it on dental care? If she is prone to cavities maybe getting her teeth coated/capped/veneered (I don't know what exactly the term is, but my dentist mentioned this as an expensive but potential future option to prevent cavities).
posted by radioamy at 8:08 PM on June 3, 2013

Can she have an appointment late in June to evaluate her eyes and plan for surgery and have the charge be $1400? Many places require a patient to pay for elective services at the time of consultation (deposits for serious dental work, etc). What exactly does the FSA need to have in order to reimburse? Several of mine have had me pay out of my pocket then submit the paid invoice (which does have to specify what it's for) in order to reimburse me. The claim wasn't filed with them, and I didn't use their provided debit card because they always screwed that up. A detailed receipt is all I needed to submit. Can the doctors office do that? Bill you for the service, you pay with a different card, get a recipt saying "LASIK left eye" or whatever, and submit for reimbursement?
posted by MultiFaceted at 8:25 PM on June 3, 2013

If you're brainstorming other things to spend the FSA money on, look up IRS Publication 502. This documents lists all the allowable FSA expenditures for the tax year.
posted by JoeZydeco at 8:28 PM on June 3, 2013

$1400 would be enough money for me to talk to a lawyer, honestly.
posted by klangklangston at 12:36 AM on June 4, 2013 [1 favorite]

This really sucks. I am sorry.

I have never fought an FSA administrator, but I've had to spend down big balances. A dental cleaning will use up around $150-200, more if they find anything. They may be able to prescribe special toothpaste or mouthwash. A doctor co-pay if she can get in this month, plus any testing she may want to get, plus prescriptions (even OTC medicines are eligible if she has a prescription for them, though some doctors get confused if you ask for a prescription and may not go along with it).

Personally I would probably use the opportunity to see a dermatologist and get some fancy skin care. Also, certain sunscreens are eligible even without a prescription. The sunscreen I like but can only afford on sale or with leftover FSA money is about $30 for 100 ml, which is a 40-day supply, so a year's worth costs about $270.

Fancy prescription eyeglasses she can use now, then after surgery have the lenses replaced with nonprescription sunglass lenses.
posted by payoto at 5:25 AM on June 4, 2013

HSA accounts work by reducing your salary by the account amount. I believe that unspent funds revert to the employer. Given the screw-up, is it possible that the employer would assist her in a workaround? I would talk to HR.
posted by theora55 at 8:37 AM on June 4, 2013

To spend your FSA if all else fails.
Top of the line first aid kits for everyone! First Aid kits are coverable. Costco has kits up to 150 dollars each and they take FSA. Hell, you might even help save a life!
posted by couchdive at 2:34 PM on June 4, 2013

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