FSA reimbursement requirements (paperwork)
June 3, 2016 10:31 AM   Subscribe

Are the requirements to get reimbursed standardized? It seems like my spouses's firm requires an awful lot of hoop-jumping.

Must every med expense be submitted to insurance? (I know it won't be paid, as it is out of network) The receipt shows what I paid, who cares what, if anything, the insurance paid?

This is a new policy for us and we just haven't gotten docs switched yet.
posted by egk to Work & Money (7 answers total)
 
My FSA was through Discovery Benefits (which was separate from my insurance, Kaiser Permanente) and it did require itemized receipts for everything. I scanned and uploaded through their portal and filled out some stuff.

That said, they did pay everything I've ever asked for, plus gas mileage reimbursement.
posted by aperturescientist at 10:52 AM on June 3, 2016


(HR assistant here) At my workplace, we've used the FSA debit card for quite some time. In years past, it was just like a bank debit card - swipe it, pay, go on your merry way. Last year, something in the IRS regulations changed and while the card was just as easy to use, the paperwork became a major pain in the ass. We suddenly had to submit original itemized receipts (not cash register printouts, detailed receipts with insurance details) to get each individual claim justified and paid. Oh, the howling and complaining from my fellow employees! Most of us decided it wasn't worth the trouble when re-enrollment time came this year. The program guidelines may vary from company to company, but I suspect the IRS controls a big chunk of the reporting, and that's why there are suddenly more hoops to jump through. Good luck!
posted by jhope71 at 10:54 AM on June 3, 2016 [1 favorite]


No--each FSA administrator will have its own claims process. But itemized receipts are generally required as not every expense is eligible for FSA reimbursement, or has strings attached (i.e., must have a prescription for psuedoephedrine).

You never need to submit claims if you don't want to, but keep in mind FSAs are typically use-it-or-lose it propositions.
posted by FergieBelle at 11:03 AM on June 3, 2016 [1 favorite]


The reason that they care what the insurance paid is that they don't want to reimburse you if you are already getting reimbursed by insurance.
posted by metahawk at 11:16 AM on June 3, 2016


Our FSA paperwork does not involve submitting proof that the expense was billed to insurance. It does require paperwork showing the name of the care provider, the patient, the service, the date, and the payment amount.
posted by moira at 11:17 AM on June 3, 2016


I don't think there is any consistency or standardization, even though the whole process is based on "IRS Guidelines." Last year we had to document every. single. purchase. This year, we haven't been asked for anything (different administrators). What annoyed me the most about the whole process last year was that the documentation I sent was usually not enough for them, which involved contacting the businesses, doctors, dentists, etc. and bothering them to create additional paperwork. Eventually this got so annoying I just started to ignore the requests for substantiation. At the end of the year I got a message from HR saying the unsubstantiated claims would be submitted to payroll as taxable income. So that seems to be the end game.
posted by Otis at 11:18 AM on June 3, 2016 [1 favorite]


Benefits Manager Here:
Technically no, not every administrator will have the same rules, they will all interpret IRS guidelines differently.

In general a receipt should have the following though:
1. Date of service
2. Description of service
3. Patient Name
4. Amount paid or owed by patient
5. Service Provider Name

So basically you need an actual receipt for the service, a summary invoice that just lists a whole year's worth of office visits or something like that usually isn't good enough.

Some administrators are more conservative than others, since you can't be reimbursed by your FSA for something your insurance paid I can see a super conservative administrator wanting proof of how much an insurance company paid before providing reimbursement.
posted by magnetsphere at 2:00 PM on June 3, 2016


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