need quick answer

[Guest kimb]

A participant is submitting an orthodontia claim for herself and she's being charged additionally for porcelain brackets. We feel this would be considered cosmetic but our client is saying it's not. What is your take on this. We need an answer soon because we're due to process the receipts tomorrow. Their asking for something in writting showing that porcelain braces for an adult is cosmetic. (We already know that the braces are for a medical reason and not cosmetic.) Can anyone guide us in the right direction for something in writting? Thanks.

[Harwood]

IRS Publication 502

Medical and Dental Expenses

What Is the Definition of Medical Care?

Medical care means amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, and for treatments affecting any part or function of the body. The medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. Medical care expenses include the premiums you pay for insurance that covers the expenses of medical care, and the amounts you pay for transportation to get medical care. Medical care expenses also include limited amounts paid for any qualified long-term care insurance contract.

Cosmetic Surgery

Generally, you cannot include in medical expenses the amount you pay for unnecessary cosmetic surgery. This applies to any procedure that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. Procedures such as face lifts, hair transplants, hair removal (electrolysis), and liposuction generally are not deductible.

You can include in medical expenses the amount you pay for cosmetic surgery if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease.

Dental Treatment

You can include in medical expenses the amounts you pay for dental treatment. This includes fees paid to dentists for X-rays, fillings, braces, extractions, dentures, etc.

[Guest JerseyGirl]

The burden of proof that the porcelain brackets are necessary ( which I do not believe) is on the participant and her dentist. not on you. I would approve the obviously necessary portion of the bill and ask for documentation on the questionable part.

That said, my first words of advice is always *check the plan document*-- does the document spell out that cosmetic procedures are excluded? Direct her to that portion of the document and the SPD.

Here's another handy thing to refer to:

http://www.fourmilab.ch/ustax/www/sections.html

Look under Section 213(d)(9)(A) for information on what is considered cosmetic in the eyes of the IRS.

Hope that helps!

[david rigby]

http://www.irs.gov/pub/irs-pdf/p502.pdf