Possible Fexible Spending Account Problem

[Cobrargc 25]

I’m having nearly $4000 set aside in my flexible spending account for 2012. I’ve always been a staunch opponent of them because of the “use it or loose it” rules. I’d called Payflex in December to see if a Lap Band surgery is an eligible healthcare expense. They told me it is as long as it’s approved by a doctor, so I thought there wouldn’t be a problem.

Today I logged into my Payflex account for the 1^st time and came across a form called “Letter of Medical Necessity “. Now I’m beginning to enter panic mode. How difficult will it be to get my general practitioner to recommend the surgery? In December I mentioned the likelihood of a Lap band surgery to my doctor during an office visit. At the time he thought it was a good idea.

I realize they are trying to weed out cosmetic surgery, but I need the surgery for many different reasons and the top reason isn’t cosmetic. I had planned to use this money to recover a portion of the surgery cost. What if I can’t obtain the medical necessity form? I wouldn’t have a prayer in the world of spending the $4000! After all, this is my money that I will be spending.

Has anyone had any similar experiences with a FSA?

[JustDoIt130 369]

I just paid for mine with my fsa- just handed over my debit card, no questions asked......and as far as I know, the rules are the rules are the rules, no matter who administers the flex account?

[vingotti33 14]

Flex spending accounts are ridiculous @ times. Some times they make it extremely difficult to get your medical expenses paid for. Your surgeon's team should be able to assist you and make it happen. If you have a high BMI with other health issues it should be simple to retrieve that money. In fact I am not sure why you have to prove anything to them, it is a medical expense. Either way if you have these issues you should be fine. Try to ge things done ASAP, that way if they keep trying to stall you can get things done before the end of the year.

[ready4therealme 41]

I just had surgery on Jan 11 and I used my FSA debit card. I do have a $5,000 limit per day so I paid for my surgery in two payments (first payment friday before surgery and then the monday before my surgery) and had no problems!

[tym4me 206]

Had to get the same letter. It was no problem an i used my fsa too

[HeavyDutyQ-tee 2]

FSA is ridiculous at times but to spend the money takes no pre-approval. Just hand them the card n it goes thru just like a credit card. After the fact the may want to verify what it was spent on with a receipt. This is were they can accept or deny but the funds are still paid to doctor. If they dont approve the transaction, your card will be put on hold until you either spend $4000 in medical expenses outta pocket n submit receipts. I think if you never verify the funds, you can't get another fsa account but you aren't punished or anything. Also if you spend your fsa up n say you quit or your terminated, you owe nothing. Thats a risk they take with these accounts. I have read n researched everything under fsa...

[Cobrargc 25]

Thanks for the information. My employer doesn't have the FSA card at this time, so all reimbursements have to be done the old fashion way.

Another wrinkle is likely going to be a paperwork trail. I plan to be a self-payer because my wonderful health insurance doesn't cover the procedure. I'm guessing that I would have to submit my BCBS insurance card to the clinic doing the surgery. This would be denied right away, but establish a paperwork trail for Pay Flex.

I'm leaning towards having the procedure in Kansas City, but am considering having Dr Ortiz do the procedure in Mexico. Lots of luck trying to get Pay flex to reimburse me for the Mexico procedure. Pay flex would paid for nearly the entire procedure!

So many things to think about and so little time. I have my 1st appointment in KC on the 2nd of February and maybe the surgery towards the end of the month.

[twi 40]

My primary Dr had to write a letter recommending surgery it was the same Dr I did my 6 month diet with its not really a big deal. You may need a co morbidity of some sort RN , high blood pressure, sleep apnea?

[jennxaz 6]

I am using my FSA. I just got my letter from my PCP and it was no problem. Don't fret about it. Make an appointment with your PCP and talk to them...it may put your mind at ease more.