Holistic Treatments

[Guest ehs]

If a holistic practitioner performs a thermogram is it necessary to request a letter of medical necessity from a primary physician? If no primary exists, is a letter from the same practitioner performing the test acceptable to document the medical condition he is treating? Would we be justified in requesting that the services be submitted to insurance first? What other forms of documentation should be requested to validate the expenses as eligible under a health care FSA?

[Lori Friedman]

Sec. 213 deductibility and Sec. 125 reimbursement aren't strictly limited to conventional medical procedures. "Nontraditional" medical care, including holistic care, is generally allowed if it's (1) performed by an experienced and qualified practitioner and (2) "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure of function of the body" [i.R.C. Sec. 213(d)(1)(A)]. There are a number of court cases and IRS rulings about the deductibility (or nontaxable Sec. 125 reimbursement) of nontraditional health care costs.

FSA reimbursement isn't precluded by the fact that the treatments weren't prescribed by an M.D. Conversely, an expense doesn't qualify for reimbursement merely because it's prescribed or recommended by an M.D.

[Guest ehs]

Sec. 213 deductibility and Sec. 125 reimbursement aren't strictly limited to conventional medical procedures. "Nontraditional" medical care, including holistic care, is generally allowed if it's (1) performed by an experienced and qualified practitioner and (2) "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure of function of the body" [i.R.C. Sec. 213(d)(1)(A)]. There are a number of court cases and IRS rulings about the deductibility (or nontaxable Sec. 125 reimbursement) of nontraditional health care costs.

FSA reimbursement isn't precluded by the fact that the treatments weren't prescribed by an M.D. Conversely, an expense doesn't qualify for reimbursement merely because it's prescribed or recommended by an M.D.

[Guest ehs]

How do we determine if a "thermogram" is an expenditure "for the purpose of affecting any structure or function of the body"? If the nature of the expense does not depend on a primary's referral or the providers title, do we "assume" that the test performed is for medical care and leave it at that? Do we request the participant to submit to insurance, with a fair amount of certainty that insurance will deny, so we are no further ahead? After spending so many years "policing" receipts or expenditures for medical necessity, it would appear that we could accept an expense at face value, regardless of the practitioner? Am I misreading your comments?

[GBurns]

ehs

Chances are your health plan does not require a referral from a primary in order for a plan participant to see an Ob-GYN or a Chiropractor? Do you question what they do in the same manner as you are now doing with this holistic practitioner? I bet no. So Why now?

Is the holistic practitioner not properly state licensed, experienced and qualified as required by the IRC?

What other purpose could a thermogram of the thyroid serve other than as a tool for diagnosis etc?

[Guest ehs]

George, thank you for your comments, however, I am unclear on whether or not we should be reimbursing any holistic treatments without question? Is that what you are suggesting?

[GBurns]

I am saying that any treatment by any licensed, qualified, expereienced practitioner should be questioned in the same manner. It makes no difference whether it is by a holistic practitioner or by an allopathic practitioner.

You do not reimburse cosmetic surgery just because it is done by a surgeon after a referral from a primary M.D. do you?

[Lori Friedman]

I'd like to pose something to those of you who frequently work with medical FSAs (either with or without cafeteria plans).

It's my understanding that an employer doesn't become the "Benefits Police" when it sponsors a medical FSA. The plan sponsor merely has to make a reasonable effort to determine that an employee has submitted an eligible expense claim. Usually, "reasonable" means:

(1) providing information and guidelines to participants

(2) obtaining documentation of a claim, and

(3) having each participant attest, when he/she signs and dates a reimbursement claim form, that the claim is for an eligible medical expense paid or incurred for the benefit of the participant, spouse, or dependents.

The employer's not held to the lofty standard of scrutinizing and investigating every request for reimbursement.

Any thoughts out there?