Orthodonture - How are you processing these claims?

[Guest MSMA]

After 2 years away from good ol' FSA, I have been temporarily pressed back into service until a new person is hired...and I need a refresher course !!!

How do orthodontic claims get paid? Do we have to push for actual dates-of-service? Or, can we reimburse based on the payment plan the patient and provider have agreed upon?

We have providers who charge the full fee up front...how do you handle that?

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ANY AND ALL INPUT GREATLY APPRECIATED !

[KJohnson]

http://www.ebia.com/weekly/articles/2001/C...HarryBeker.html

[Lisa Hand]

Please note the 1997 IRS letter referenced at the end of those informal comments, says it is at the employer's discretion whether they choose to reimburse up front or over the course of the treatment. Each plan sponsor should evaluate how they wish to approach this issue and clearly state in their SPD and other educational materials how this specific expense is addressed. Obviously, the risk is lower to the plan sponsor if reimbursed over the course of treatment. Additionally, it is often more benefical to the participant, since orthodontia is often more than the annual Medical FSA maximum permitted by their plan for one plan year.

Bottom line is either choice should be well documented and educated to participants and uniformly applied to all eligible employees.