Flexible Spending Reimbursement

[babeqq]

What is the name of your state (only U.S. law)? OH

I am in a situation where my flexible spending administrator won't reimburse me for the medical expenses I paid. I would like to know what kind of legal actions can I take if I have a case.

The story is I went into the hospital (Cleveland Clinic Hillcrest Hospital) on 1/5 at 8pm when my labor started. Half an hour after midnight, I delivered. So my baby's birthday is 1/6. Due to this life event, I increased my flexible spending account amount (active 1/6) to cover the delivery/hospital service.

Cleveland Clinic billed the entire Room/Board/Delivery for the 1/5 date (when I was admitted), even though it is for 1/5 to 1/8. I requested an itemized bill from Cleveland Clinic to show that the date of service is from 1/5 to 1/8. So, by fsa policy, I should be able to get reimbursement for services dated 1/6 to 1/8. However, the itemized bill responded by Cleveland Clinic only shows the before insurance amount. The insurance adjustment is only reflected as a total. The reason for that is Cleveland Clinic bill the whole Labor/Deliver as ONE package to the insurance company. No one has a real itemized statement at this point.

I have been on the phone with Cleveland Clinic, my insurance company and the flexible spending administrator numerous times and no one is able to provide a resolution. I had asked Cleveland Clinic to rebill this service itemized and they refused! My insurance company couldn't do anything. The flexible spending administrator refuses to acknowledge that the date of service covers 1/6, 1/7 and 1/8 even with the "before insurance" itemized statement.

What can I do next?

 

[ecmst12]

They are billing correctly. All hospital stays start on the admission date. The baby's bills should be dated for the date of birth.

 

[swalsh411]

You can be reimbursed for baby related expenses starting on 1/6. Delivery related expenses will be billed as 1/5 which is when you were admitted.

And for the record, the qualifying event is the birth, not your delivery and related expenses, so it is entirely proper that you not be reimbursed for those. Sounds like you did not understand this.

edit: If, heaven forbid, the baby had been born stillborn on 1/6 and incurred no baby related bills, you could not be reimbursed for anything.

 

[ecmst12]

I don't understand why you didn't increase your FSA amount at open enrollment, it's not like you didn't know you would be giving birth.

 

[swalsh411]

I don't understand why you didn't increase your FSA amount at open enrollment, it's not like you didn't know you would be giving birth.

A person does not know that. Unfortunately, sometimes (more often than many people believe) pregnancies end with no viable baby.

 

[ecmst12]

Even in those cases, there will usually be hospital charges involved.

 

[cbg]

A person does not know that. Unfortunately, sometimes (more often than many people believe) pregnancies end with no viable baby.

So your contention is that no one should enroll in an FSA plan if their expenses are going to be used related to a pregnancy or birth, because MAYBE there will be a miscarriage or stillbirth?

Sometimes I really don't believe you're real. Particularly since there does not appear to be any relevance to the OP's situation.

 

[babeqq]

I don't understand why you didn't increase your FSA amount at open enrollment, it's not like you didn't know you would be giving birth.

Seems like you don't have kids, or your kids come exactly on the due date.
Open enrollment is in November. My baby could have arrived on Dec 31st, 2012. Why would I plan to lose it at the end?

 

[Antigone*]

Seems like you don't have kids, or your kids come exactly on the due date.
Open enrollment is in November. My baby could have arrived on Dec 31st, 2012. Why would I plan to lose it at the end?

It has nothing to do with having kids, lady. You knew you were going to have this kids so during open enrollment you should have been more planful. Had you been planful, you'd be enjoying your baby at this moment instead of fretting over the hospital bill.

If you are not covered until the 6th, then it looks like you are going to have to fork over some after-tax cash.

 

[ecmst12]

Chances are, you still would have found something to use the money on sometime during the year, with a new baby. But I do see your point that you didn't know which year you would be giving birth. However, that does not change the fact that the hospital is billing your charges correctly and you won't be able to use the FSA money for charges prior to the qualifying event (baby's birth).

 

[babeqq]

You can be reimbursed for baby related expenses starting on 1/6. Delivery related expenses will be billed as 1/5 which is when you were admitted.

And for the record, the qualifying event is the birth, not your delivery and related expenses, so it is entirely proper that you not be reimbursed for those. Sounds like you did not understand this.

edit: If, heaven forbid, the baby had been born stillborn on 1/6 and incurred no baby related bills, you could not be reimbursed for anything.

So, how come OB's delivery charge is billed 1/6, which is when the delivery/birth actually took place? It's not billed when I was actually admitted? According to your reasoning, Cleveland Clinic should bill OB, bill Anesthesiologist, and everything else related to the mother on 1/5. But they don't. It is inconsistent practice.

And as for your hypothetical case, without a qualifying event, I will NOT be able to change FSA. As a result, I won't be here looking for help to get some of the FSA money back that is lose it if not use it.

 

[Antigone*]

CBG, honey please correct me if I am wrong.

OP should have signed up for the Flex account during open enrollment in November. This would have taken effect January 1, right? The deductions to her paycheck and the benefit amounts would not have gone into effect until Jan 1, right?

Now if my thinking is correct, then why on earth did the OP wait until Jan 6th to enroll?

 

[ecmst12]

She contends that she did not increase the amount for open enrollment because she was not sure whether she would give birth in 2012 or 2013. Which is plausible, but unfortunately does not change her predicament.

 

[babeqq]

Chances are, you still would have found something to use the money on sometime during the year, with a new baby. But I do see your point that you didn't know which year you would be giving birth. However, that does not change the fact that the hospital is billing your charges correctly and you won't be able to use the FSA money for charges prior to the qualifying event (baby's birth).

I'm not arguing for the FSA money prior to the qualifying event(baby's birth). I am arguing for the money after the qualifying event. So a majority of the 1/5 bill is actually for 1/6, 1/7 and 1/8 service. I am asking for ways to reimburse for the service dates 1/6, 1/7 and 1/8.

The EOB states the amount is for 1/5 to 1/8. Why is it alright to ignore the service dates by an FSA administrator? Doesn't the guideline state that the reimbursement is per service date?

 

[Antigone*]

She contends that she did not increase the amount for open enrollment because she was not sure whether she would give birth in 2012 or 2013. Which is plausible, but unfortunately does not change her predicament.

Got it now. However it is a gamble she decided to take - and lost.