Celiac Disease

[Guest moseelig]

A participant's child has been diagnosed with Celiac disease; are books on coping/living with the disease, and cookbooks reimbursable through the FSA?

[J Simmons]

I would think so if the celiac disease diagnosis was made by a physician and the physician has recommended the books, and the books were written specifically for those suffering celiac disease. This would not be for mere general health, but for a specifically diagnosed condition or ailment.

[QDROphile]

You still have to fit the standards for medical care. Recommendation by a health professional is very helpful, but how do the books fit with the specific terms of the statute and regulations? I am skeptical.

[Guest TXCafe]

You still have to fit the standards for medical care. Recommendation by a health professional is very helpful, but how do the books fit with the specific terms of the statute and regulations? I am skeptical.

I would say it wouldn't qualify. It doesn't fit the "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body" portion of Section 213 in my opinion. Although I suppose it might broadly fit into the "prevention of disease" category. It seems like a stretch to me. But if you could get the doctor's note and feel confident of making a case that it fits in the 213 description of an eligible expense, by all means reimburse it. Just my $.02.

[Guest CassieG]

I think it could qualify as treatment and/or mitigation for the disease, as it does require a significant change in eating habits, etc.

[Guest Norah]

Celiac runs in my husband's family. At a basic level the treatment for Celiac is to not eat any foods that contain gluten, period. I can see where the books and cookbooks could come into play to treat the disease, as most people would be amazed at how prevelant wheat based products are in foods.

I would ask for a doctor's prescription and/or certification that the expenses are necessary for the treatment of the disease in order to make it an eligible expense. If the doctor does write that, then yes, I would say it is allowed.

[Guest buttercup]

No, the cost of books would not be a covered expense. Of course, the cost of the gluten free food would be a covered expense with a letter of med. necessity as well as any sort of vitamins for the Celiac Diesease.

A participant's child has been diagnosed with Celiac disease; are books on coping/living with the disease, and cookbooks reimbursable through the FSA?

[LRDG]

Edited to add: Curious if there has been any official or unofficial explanation of the impact of recent addition of OTCs paid with FSA funds and the medically necessary standard in Sec. 213?

Can the plan deny the claim for Celaic Disease food preperation/dietary instruction in this claim, but reimburse another OTC medical tretement for Celiac, a disorder of the digestive system, for which the primary treatment is a gluten free diet.

Versus reimbursing an OTC cold medication that does not require a dx, no supporting documentation, no physician name, no patient name, with presentation of a register receipt with 'Tylenol' or barely recognizable abreviation for same.

Sec. 213 is the standard for making an eligibility determination, IMO. I would require a RX from the dx-ing physician, but in light of the OTC standard, I'm not sure I would deny this claim based on the nature of the disorder, the OTC treatment via dietary restriction of gluten, food preperation instruction for gluten free diet, with a record of the dx'ing physician, and patient's identity and dx is known.

[LRDG]

Gluten free diets are not eligible for 100% reimbursement from a medical FSA.

The cost of a medically necessary diet is reimbursible only to the extent the cost of the special diet exceeds the cost of a regular diet.

Example: Gluten free bread cost $4.00, regular bread cost $3.00, the eligible deduction is $1.00.

[Guest TXCafe]

Gluten free diets are not eligible for 100% reimbursement from a medical FSA.

The cost of a medically necessary diet is reimbursible only to the extent the cost of the special diet exceeds the cost of a regular diet.

Example: Gluten free bread cost $4.00, regular bread cost $3.00, the eligible deduction is $1.00.

I totally agree with that conclusion. How do you make the determination for the "usual" cost? I had a claim for orthopedic shoes a few months ago. I looked in my EBIA manual and it states that orthopedic shoes are reimburseable only to the extent that the cost exceeds the cost of a regular pair of shoes...same vein of thought as the excess cost of gluten free food. I guesstimated the cost of a regular pair of shoes at I think $50 and reimbursed the amount claimed over $50. That was purely my guess though. I know that some of my shoes cost more and some cost less...of course, I'm also a woman and this was for a man's shoes. Do yall have any thoughts on a consistent, fair way to ascertain the "normal" cost of items like this? I know I buy multi-grain bread normally which is more expensive than white bread...how would someone know how much more I have to spend on gluten-free bread(speaking rhetorically of course)? I would like to hear any thoughts out there on this.

[LRDG]

I know little about disorders and specialized services/items associated with 'over the usual cost'. Participants and service providers are a primary source of information about disorders and expenses. I would take advantage of information provided by participants and service providers.

Example: Participant purchases shoes retail and has ortho work on a shoe that includes specialized services necessary for the customized work. Making a determination is fairly straight forward, deduct the retail cost from the cost of the orthopedic work, reimburse the balance.

There may not always be a retail equiveliant. Corrective shoes are often available only from an ortho shoe specialist. An attempt to establish a retail equiveliant might be like comparing the cost of an unrestricted, retail grocery store diet with an IV drip for solid/liquid restricted diet, and impossible to arrive at a cost equivelient.

IV for solid/liquid restricted diet would be administered in a hospital setting and usually covered by insurance. When establishing retail equiveliant is a problem, I'd request an EOB from the insurance carrier, (if not covered, it would establish a dx), reimburse participant based on the EOB, less a nominial amount representing retail value of shoes.

For documentation purposes and to establish price, request participant provide an advertisement from a well known retailer, or a written receipt/estimate from retailer. Reimburse based on the EOB, less retail cost.

I would't hesitate to use a Payless type of retailer. The ortho shoe is more medical treatment than the utilitarian clothing item shoes usually represent to the rest of the population.

Usually only one shoe/foot is involved. Should reimbursement be based on 1/2 of the retail value of a pair of shoes? It's not even possible to purchase one shoe, however it is possible to establish the value of one shoe.

Sec. 213 does not require treatment be the least expensive available to the tax payer. For example, the deduction allowed for Lasik surgery vs. deduction for eyeglases is based on the cost of the procedure chosen by the tax payer/participant.

File insurance claim for EOB, use documentation such as advertisement or written receipt/estimate from retailer provided by participant, receipts from ortho service provider. If in serious doubt about a procedure, defer to plan sponsor 'claims committee'.