We all spend too much time fighting insurance coverage battles, am I right? This humongous time-sink can be one of the worst things about living with a chronic illness. But don’t take my word for it. Take a read on fellow D-blogger and journalist Mike Hoskins’ latest row:
Special to the ‘Mine by Mike Hoskins
Like most of you, we spend thousands of dollars in diabetes supplies and meds every year.
Thankfully, our insurance coverage provides a Flex Spending Account (FSA) to help us not have to eat through this money on the front end. It’s a simple concept: money you earn goes into a pot to be used during the course of a year to pay for certain medical supplies. Submit receipts to prove that all is legit, and personal money spent is reimbursed forthwith.
At least, that’s how it should work.
Not for us, with the newest FSA company we’re dealing with.
The evil villain of a company known as Aflac has kicked of a three-month battle that we’ve yet to win. Rather than getting reimbursed, we’re on the receiving end of hair-pulling, teeth-clenching, curse-inducing thoughts of violence for what we’ve had to endure. These days, I certainly don’t feel like I have a stock-pile of D-supply cash ready at the swipe of a plastic card. In fact, I’m truly starting to believe that the whole Flex Spending Account initiative is a scam – just a way to coax people into putting up money that’s supposed to help them save on healthcare bills, but in reality will disappear into the abyss of company double-talk and lousy record-keeping.
Luckily, I’ve resisted the temptation to throw my phone against a wall – mostly because I know I’d be less able to make the calls that are still on the horizon.
Aside from that, about the only other thing I have to be thankful for is that I’ve managed to avoid a mental breakdown because my wife (the faithful policy-holder via her job) has been navigating some of the Flex Fiasco. I deal with most of the insurance coverage calls, because I’ve been dealing with these people for most of my life. But since her name’s on the Flex plan, she takes the lead initially. When they won’t play nicely, the ball gets knocked into my part of the grassy field.
That’s where we found ourselves early this year. The company wanted more documentation about some particular receipts we’d sent in for reimbursement. A root canal. Monthly medications from the pharmacy. Insulin. Some office visits with my endo and my mental health counselor. To the tune of $1,200.
Somehow they decided the already-submitted info was not good enough, so they suddenly deactivated our Flex card, forcing us to pay for everything up front and then go back to them to fight for reimbursement.
So I started calling, to get to the bottom of this mystery and apparent communication failure and find out what they specifically needed to restart our card — and start offering the promised payback (from money we saved ourselves, no less!)
The first conversation was doomed from the start.
First of all, when I provide you with the policy-holder’s name and account number, please don’t tell me that the account doesn’t exist or that I must be mistaken in thinking we have a Flex Plan. No, you just need to correctly key in the information.
And then when you cut me off, and I call back, don’t tell me that you can only provide information to my wife, the policy holder – when she’s already approved. This doesn’t help the customer’s faith that you can perform simple tasks, like reading and comprehending what’s on a computer screen.
Me: So the receipts from each provider listing the services aren’t good enough?
Flex Lady: No, we need individualized receipts.
Me: That’s what I sent. Receipts, showing the reason for the visit or medicine I got from the pharmacy.
Flex Lady: No, you didn’t. That’s not enough.
Me: I don’t understand. The receipts we sent are from the pharmacy we use, and each item says “pharmacy” with the cost of the medication purchased. Or the doctor’s office that says why we were there. What else do we need to send?
Flex Lady: A more detailed breakdown of everything.
For every other Flex company we’ve had through the years, submitting a receipt from the pharmacy was adequate. But not this time. Apparently we need to send in a list detailing every medication, dosage, patient name and cost breakdown of each item.
We’ve never had to do this before, and at first I thought it might be some new policy mandated by (*gasp*) that big bad health care reform that’s causing the sky to spit glucose. Apparently not. Aflac says this has been its own policy for years.
So basically, rather than relying on simple receipts as I’ve always done, this means I must contact each individual doctor’s office or provider for more detailed itemized receipts. If they don’t break everything down exactly the way Aflac wants, then I need to circle back, re-submit a request and follow up on each one, or sacrifice the money we’ve invested in medical reimbursement. Ouch!! As if work, life and diabetes didn’t keep us busy enough!
Seriously, if it wasn’t for their talking duck mascot, I’d have nothing positive to say about these people… Then again, I don’t. I kind of want to wring my hands around the duck’s 
neck right about now…
For each drug or supply, they want a pharmacy receipt with a signature at the end. Even though we sent three pages of information with a signature following on the last page… I guess reading through all the pages isn’t as easy for them as just demanding a new fax. But then again, who cares what’s easy for them? What about us customers?!
Then there’s the whole song-and-dance of justifying the reimbursement I’m asking for, which I’m not even sure is legal.
One receipt was for blood glucose test strips. This different Flex Representative wanted to know not only how many, but that my doctor has signed off on the amount of strips requested (duh, he wrote the prescription!).
Me: I’m sorry, but why do you need to know that?
Flex Lady 2: We have to make sure you’re not listing thing that you don’t use, or in amounts that aren’t necessary.
Me: That’s a discussion between my doctor and I, and possibly my health insurance people. Not you. This is about getting reimbursed for covered supplies that I’ve already paid for!
Flex Lady 2: We still need to confirm it.
The thought of stabbing myself in the eyes with blunt lancets danced around in my head, but I resisted. Colorful catch phrases were on the tip of my tongue, a la Marcus Grimm’s “Sh*t Diabetics Say.”
Tact prevailed, and instead I clenched my fists and eyes and shook my head silently.
This whole Flex Fiasco has gone on for weeks, with each situation leading to what appears to be a solution but later turning out to be wasted time. Minutes and hours I’ll never get back…
They’ve wanted more proof that I saw my dentist for the listed purposes, rather than – I don’t know – a foot exam or stress test… or maybe just a chat?!
They’ve refused to take my word that my visits to a mental health counselor, a Licensed Counselor and Social Worker, is for actual mental health evaluation. Apparently, the credentials aren’t good enough and it might be possible I’m paying $35 a week just to meet for a weekly game of poker, rather than therapy.
Hmmm… This brings a question to mind: Is this even allowed??? Doesn’t a little thing called HIPAA prevent them from asking me for all these details? Seems like it should. At least I think so. I’m tempted to contact my past flex providers just to see if this current situation is something out of left field. But that would take more hours I can’t afford to give away…
Meanwhile, after all the conversations we’ve had on the phone with these people, they’ve knocked off way too many trees by sending us waves of statements in the mail. They deny our reimbursement claims, telling us that we’ll lose our untapped money if it’s not claimed by May. Yet they won’t let us claim it…
YOU’VE GOT TO BE KIDDING!!
(Sigh, again. Face into palm.)
;
You wouldn’t think that health care providers and insurance companies would need advice on how to run their businesses, but apparently they do. So here’s what I’d suggest:
1. Hire people to answer the phone who actually know what the heck they’re talking about and can offer correct answers to their customers, who are simply trying to get what they need to be healthy.
2. Provide care that actually helps people, not just your bottom line or other companies and insurance carriers.
3. If you cover someone with insurance or provide them with a FSA, then COVER us or allow us to get that money when we follow the rules. Please don’t assume we’re trying to cheat you (we’re NOT guilty until proven innocent). We pay you money for a reason.
4. Stop asking to confirm our information every time you breath. Seriously. Look at the computer screen in front of you. Use the information already recorded. We shouldn’t have to repeat ourselves ad nauseum simply because you can’t comprehend the concept of teamwork.
5. Talk to me like another human — not a person with a condition that you think is evil and not worth covering or providing (OUR) money for.
6. Don’t tell me what you want me to want. I called you, not the other way around. Please listen to me and do your job. Honestly, I’m not trying to needlessly take up your time.
And so, the Flex Fiasco continues… Hopefully some remedy can be found before the end of May, when our benefits reset and whatever money’s left in that account actually does go down the drain.
We shouldn’t have to fight these battles. But apparently, that’s just the way it is. Because apparently, listening to us patients isn’t an option. And logic must fly in the face of… common sense.
Write a letter to your state attorney general and insurance commissioner. Send Aflec’s COO a copy. Usually gets someone’s attention.
You have my heartfelt sympathy. And thank you for publicizing AFLAC’s behavior. This isn’t normal even for profit-grabbing insurance industry norms and no one in their right mind should accept it.
That sucks Mike, at this point I’d involve the State Insurance Commissioner (I think that is who regulates Flex accounts anyway) because I do believe they are at least “distorting” the regulations if not outright ignoring them.
I had a similar occurrence earlier this year when my Flex folks wanted a letter of medical necessity for dexcom sensors. I told them they were req’d a doctor’s prescription to obtain and to show me the statute that let them require information beyond the detailed invoice I had provided. Turns out, what they already has was sufficient…
I think you should send this article to the New York Times. You should not have to suffer like this. I tried the flex savings one time but it was absolutely too much paperwork. and I didn’t like the monthly fee they charged. TG I didn’t have AFLAC.
Oh Mike, I’m so sorry for the crap you’re going through. It feels like there’s an even deeper level of evil and frustration b/c it’s YOUR MONEY, right?!? Even higher pile of doo-doo than the “regular” insurance crap. Urgh. I think Scott has a point about contacting your state insurance commissioner’s office–they are supposed to want to hear from consumers who are having problems with coverage/services/companies, and I think your experiences would be right at the top of that list! Also, is there someone at your wife’s employer who coordinates the benefits, and/or who works with an benefits broker to do so, that she/you could ask for help in communicating with the evil duck? I’ve gone that route a few times for various insurance issues before. Brokers have power we individuals do not, at least a little. GOOD LUCK.
We’ve had the same thing happen with Humana. Make a claim and have it denied, and then the original paperwork is lost, and can you re-send ? Over and over to get our flexible spending account money back. The last time, my husband re-faxed the information, and told them if we didn’t get our money right away, the lawyer would be called. That worked!
That is crazy. I agree with Scott, contact the State Insurance Commissioner or whoever handles flex accounts. When I had mine, we were allowed certain OTC items and I can see needing something from the doctor that you needed those vitamins but not prescriptions or doctors receipts. I don’t think that there is anything in the flex laws that say they need to know why you were at the doctor. It saying office visit should be all they need to know.
Michael I feel your pain. I tried to convince my insurance company that an insulin pump was a need and not a want. So sad how you have to beg for coverage.
So sad
Mike –
THAT SUCKS.
I agree with Scott, contact the State Insurance Commissioner, Also, I’d send your receipts in via certified mail or Fed – So you can find out when they got it and who actually signed for it. It’s such bullsh*t that you have to go through this. You’re doing everything you’re supposed to on your end, and they are dropping the ball in order not to pay your medical expenses.
Keep up the good fight my friend!
I’ve always thought that the concept of FSAs was weak at best. Why not put the same money aside in a personal bank account instead of possibly having to fight with insurance morons trying to confiscate what amounts to a savings account???? If a bank did that to you, you would never let them handle a cent of your money again!!
What a pain in the pancreas!!
My current fsa is the first time that I don’t need to submit any receipts unless they ask for them. So my doctor’s visits and pharmacy purchases are routine and I never have to submit anything.
I did have to submit documentation for my eyeglasses, but that was all done virtually and was a piece of sugar-free cake.
Get with it AFLAC!
I agree with Scott. Take this higher. This is absolutely absurd. And HIPAA has to fall in here somewhere. Besides, it is YOUR money. And the biggest advantage is that it’s tax free. So if anyone should be upset, it should be the government, not Aflac. But then again, I imagine at the end of May, they get that money of YOURS that YOU don’t get back.
Seriously, this is absurd! I am so sorry you are going through this. Today, I posted about the ridiculousness of doctors. Healthcare is wonderful when it works. It’s dreadful and nearly useless when it doesn’t.
Mike – you have demonstrated an unusual amount of patience with Aflac. The Flexible Spending Account is authorized by federal law. It appears to me that Aflac, the FSA administrator, is deliberately making it very difficult for you to claim *your* money! In fact it make me suspicious that Aflac may receive some kind of compensation based on the amount of unclaimed money.
In addition to contacting your state insurance commissioner, I would find a federal enforcement agent to help you. I know that there is a new federal consumer agency that helps consumers with all manner of things financial. You may even want to contact the constituent services person at your Congress member’s office. This is an outrage!
I worked for a large international airline before I retired. Their administration was exceptionally good. When a health insurance claim was finalized, a record of it was electronically submitted to the FSA administrator and the money was automatically deposited into my checking account. There were times when the FSA money was deposited in my account before I received the explanation of benefits form!
I for one would be interested how this all works out for you. Good luck. You should not have to fight for your money!
I actually work for an FSA administrator so maybe I could shed some light.
First, freezing the card is a rather standard procedure when an expense requires substantiation and it was not received. The IRS requires substantiation on all expenses, but with the debit cards they can have certain auto-substantiation methods that don’t require the physical receipts. When that doesn’t work they’ll typically ask by email for the actual medical documentation, and if not supplied after a certain time,. or the expense was deemed ineligible, the will freeze the card until it is sorted out.
As far as documentation, the IRS requires certain items on any documentation for reimbursement:
-Name and address of the service provider
– Date service/expense was incurred
– Name of person for whom service/expense was provided
– Detailed description of the service/expense provided
-Amount charged for the service
They also do not allow credit card receipts as sufficient documentation, and that can be murky sometimes what that actually means, even if all the information is available on it. Sometimes it’s necessary for the Merchant to actually draw up by hand a medical invoice that supplies the information, as sometimes they only offer credit card receipts. When in doubt, an Explanation of Benefits from the insurance carrier, if applicable, is always the best form of documentation.
Most over-the-counter medications and items do actually require a doctor’s prescription to be eligible. This was part of the health care reform law that was passed. Anything diabetic, however, should be exempt and you should be able to use an FSA card or submit for reimbursement without an RX.
It sounds like your administrator is being very cautious of what is being reimbursed. Ultimately though it is to serve your company and the employees. The risk of having a non-compliant plan reimbursing ineligible expenses could cause the company and their employees to lose their tax-free eligibility retroactive to the beginning of the plan’s first start date!
In the end, the administrator serves your employer. If there is a discrepancy in reimbursements you should be able to bring it up with your HR Department, who can advise the administrator how to proceed. If you can show your HR Department that these expenses are eligible, they can let the administrator know to reimburse them.
Hope that helps.
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Sincerly,
Nick
Mike – sorry to hear about your troubles with FSAs. Many folks face the documentation challenge in the name of saving money. If you’re interested in a creative solution, take a look at this video (http://www.flexminder.com/how-it-works/), hopefully it will at least make you smile
.
-Will
Tell them you want to talk to the Duck. AFLAC!