Wanted: Your opinion on how to pay this orthodontic claim

[Guest MSMA]

Once again the orthodontic beast has raised it's ugly head...

After much debate here, I am putting the question to you:

Received a receipt (for $1,075) for "...payment for orthodontic payment plan covering services September 2002 through June 2003." With the language specifying "payment plan" instead of dates-of-service - and especially where they are looking for PRE-payment...I just don't feel that this is compensable under FSA.

WHAT IS YOUR SAGE ADVICE?

Oh, and just to make things more fun...the handwriting on the receipt closely matches the handwriting on the claim form... We have caught 3 participants in 5 years from this very same employer very clearly forging receipts. And 2 of them were done really badly too...

[papogi]

According to Harry Beker, employers have some room to interpret the regs with regard to ortho to allow up front reimbursement, or to require a schedule from the orthodontist so that you can more easily match actual services with FSA reimbursements. Personally, I would request further info from the employee and orthodontist so that you can have a more conservative interpretation of the regs. I would make every attempt to make sure that only the 2002 expenses are reimbursed from the 2002 FSA, and the 2003 expenses from that account. You have every right to require further documentation in a gray area such as this. If the employee doesn't like it, he/she can try the Schedule A route for this medical expense (with the well documented limitations). Again, it seems you don't have to do this, however.

[Guest Carolynn]

Wondering about your experience with the forgeries - what was your response and how did the employer deal with it? We've had one such forgery, it was done very well, if I hadn't called the DDS to clarify, we would never have known. Unfortunately, the employer didn't seem to care very much and made little or no attempt to get the money back from the participant.

Regarding your question, you may consider calling the DDS to clarify any question you may have, and of course, I would never consider paying ortho in advance. We take the conservative stand, and pay out each month the total amount due divided by the estimated number of treatment months. This is automated, it's not as much trouble as it might sound like!

Carolynn

[Lisa Hand]

Carolynn:

We have had some experience with forgeries. However, unlike the employer in your example, the ones we work with consider fraud grounds for termination and publish it as such in their employee handbooks.

We also work in a very conservative environment and strongly suggest that the employer publish in their enrollment information specifically how orthodonita is handled, which is usually dollars to service and documentation required from the orthodontist.