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Fsa Flexible Spending Account / Claim Denial

1 United States Review updated:
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I left a company in July and had filed for a FSA with them through CreativeBenefits now know as WageWorks. I received a balance reminder from them 6 months later stating that I had about $220 in their accounts and that I was able to use that until 12/31/09. So on 12/29/09 I went to the local pharmacy and stocked up on misc items mostly all covered by FSAs. I went online and filed the claim for the items that qualified for the amount that was totaled as FSA compliant on the receipt.

A few days later I received a notice that I had been denied on all claims. Calling the customer service line was next to useless until I found the buried line to a representative. After waiting on hold for 5 minutes the call started dialing a rep then disconnected me... Going through the process again I was finally connected to a rep and we discussed the issue. As it turns out you are only covered by the FSA as long as you are employed by the original employer. When asked about the Billing notice stating the $200+ account balance, the rep stated that those are all automated and that it doesn't take into account the employment status of an individual. After giving her a piece of my mind about how that is misleading and costs my hundreds of dollars she agreed and stated that if she didn't work there she would find them confusing also... She then stated that in fact I didn't actually lose the $220 something dollars the account said I had, instead I only lost what I had deposited, which was less then what I had elected for when I signed up for the FSA. So infact the statement I had received was even more misleading in the fact that it stated I had cash in an account that I didn't actually have.

This place is completely ignorant and oblivious to their customer. They have potentially cost me hundred of dollars and I'm sure that there are other that have lost much, much more then that. I agree that if your company offers an FSA with WageWorks/Creative Benefits, run the other way and just pay the taxable amount rather then spending extra time dealing with the circus that is WageWorks.

Fsa Flexible Spending Account

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Comments

  • Sa
      8th of Jun, 2010
    0 Votes

    I totally agree that something is seriously wrong with the way that wage work does not actually work. It seems the government rules are created in an effort to take money from the individuals who elect to use it. I mean I went to a dentist, and there were numerous charges that was placed on the account . There was a charge for about $95 and after all this is coming out of my pay to the tune of $104 bi-weekly. now they question what the charge was for at the dental office. Now this is simply ignorant! If I in fact went to the dentist, I did not perchase...food, clothing, alcohol, concert tickets! My point is that the establishment should have been sufficient. Futhermore I feel that if someone wanted to purchase mouthwash, dental floss, eye wash that should be allowed. If someone on the other hand went to say walgreens and purchased cigarettes, then that of course would be blatent mis-use of the intended purpose. Simply stated wageworks needs to stop being so petty and greedy, hoping that the average joe will lose and not use their benefits, which they eventually are the ones to pay for, too much government interference, thats the problem period.

  • Nu
      28th of Jul, 2010
    0 Votes

    We are going through the same thing with WageWorks. Each year they lock up our account claiming that our medical expenses are in question. Upon receiving the receipts for the charges, they denied every one of them. They stated that the receipts did not provide them with the needed information to approve the charges. When I questioned how a detailed bill showing each and every expense was not providing them with enough information, they said that it was because the bills show how much the insurance company is to cover. Now they want me to PROVE that the insurance company did not really cover more than was expected. Please! The doctors office knows exactly what portion is going to be paid by the insurance company. They have never been wrong before. Many expenses require preauthorization from the insurance company before the office will even schedule them.

    They always look for an excuse to reject claims. Now they are sitting on $1500.00 of my money, and will not let me use it until I provide them with evidence from my insurance company that they 0nly paid their portion. As for the disconnecting. They are big on that one. Each time they claim they are going to transfer me to a supervisor, the line goes dead.

    Anyone know who to direct complaints to? They should not be allowed to continue this.

  • Do
      13th of Sep, 2010
    0 Votes

    OK, here's the situation...

    When you choose to take advantage of a pre-tax benefit, such as an FSA, you are responsible to follow the guidelines of the program. Third party administrators like WageWorks are hired by your employers to ensure IRS compliance. Keep in mind, FSAs are participant driven accounts and it is your responsibility to adhere to these rules and understand how the plan works. It is your responsibility to know when you can and can't incur expenses and what expenses are eligible.

    The IRS states that every claim or card transaction pertaining to an FSA has to be substantiated by a 3rd party to ensure the expense is eligible for reimbursment. The IRS clearly states what they consider to be an eligible expense and what documentation is considered sufficient to substantiate them.

    Dental claims can be complicated...
    Many times you are charged the "estimated patient responsibility" by your dental provider. They then submit their claim to your insurance, insurance pays their portion, and in many cases your "estimate" was incorrect. I have seen patients overcharged by $100s on over 100 occasions. The IRS only allows you to be reimbursed for your actual patient responsibility and cannot determine this based on the dentist's estimated amount. If insurance was billed, you will either need to submit an itemized statement that shows what your responsibility is AFTER your ins paid their part or an Explanation of Benefits from you ins provider from that date of service.
    Also, everything you pay for at a dental provider is not eligible for reimbursement. For example- toothbrushes and toothpastes (even special ones), teeth whitening, and most veneers are all ineligible. So, unless you submit documentation stating what the expense was for it cannot be automatically substantiated just because it was at a dentist.


    Hope this helps clear a few things up. Good luck!

  • Ja
      2nd of Jan, 2019
    0 Votes

    @Don't shoot the messenger... This complaint was about customer service! The third party company needs to guide them through the process not the other way around. The idea is for a third party vendor to help with that process. Otherwise, there is no need for a third party because the person can do this all themselves. I have to agree with everyone else on this forum. That company is totally worthless.

  • An
      17th of Oct, 2011
    0 Votes

    This is just another great example of how the health care system is broken. It is pretty much completely hidden that the benefits program does not receive that money either left in an account when you leave your job, the company you left or who fired you gets it all back, and they did not even match your contribution in most cases. There are no windows that allow you a grace period to spend your balance, so if you're fired that's it, you can only submit expenses you incurred before getting fired. Not even a CORBA like comparison as far as benefits go. Considering our 401k "benefits" that don't fully vest in lots of places for years, and the company you work for gets all that back also, it seem like the IRS could at least help the consumer/employee out on this one. This is a shameful guideline and there is not a single "good and rational" reason that your plan should not be active for what you have put in for the entire term like you are led to believe. After 90 days ADP just forks all you're money right back to your employer. It really seems like a great benefit to the companies aligned with the program providers. I'd like to see how much money some of the big companies rake in every year with this. Fraud if you ask me.

  • Al
      23rd of Nov, 2011
    0 Votes

    I don't think I ever had a FSA that was.t plagued by denials. Everyone must keep in mind that BILLS and RECEIPTS are not the same thing. Bills usually contain all of the information that FSAs need for payment offices routinely provide itemized bills. However, FSA administrators want receipts to see what you actually paid. So somehow you have to get a receipt that contains all of the info on an itemized bill or explanation of benefits - not easy to get. And remember - the FSA administrators have lots to gain by finding every reason to deny claims like a mistake in a date or amount

  • Bo
      22nd of Jan, 2013
    0 Votes

    The only FSA that I had plagued by denials and incompetent processors was American Fidelity. If your organization plans to or uses them, I suggest that you advocate for someone else.

  • Sc
      2nd of Apr, 2015
    0 Votes

    I arrived at this site because of my dilemma with ADP. They didn't follow any of the guidelines set by the US Department of Labor nor the IRS, then do whatever they wish to anyone who files a claim or an appeal. I have filed two Appeals with them, and they treat the Appeal as a Duplicate Submission, sending out the same Rejection Notice each time because the claim was rejected previously. What Appeal Process is this? There is no oversight for them, and therefore, they do whatever they want to do with no regard to rules and guidelines. I sent a complaint to the Atlanta Better Business Bureau, and they refused to act on it. They told me to contact the Insurance and Fire Safety Commission. I did. They said they were sorry, but the Flex Spending Plans are outside their jurisdiction. I think the Flex Spending Plans are outside everyone's jurisdiction. I haven't found any governmental agency that will admit to having any jurisdiction over these Spending Accounts.

  • Ma
      15th of Oct, 2015
    0 Votes

    I actually work for a major employer's benefit office (no direct oversight over contracted vendors). I know the rules extremely well and follow them to a tee. Even I can't get Payflex to reimburse for an excruciatingly detailed claim for a legitimate medical procedure that is not covered by insurance. They are demanding an explanation of benefits that can never be obtained, because the prescription medical procedure is new, and not covered by insurance. The person who oversees the medical plan administrator has notified Payflex that the procedure is allowable, but not covered by medical insurance, but they still sit on the flexible spending claim.

    One problem, in my view, is that flexible spending plan administrators like Payflex make very little money on administering these plans. My employer would get any unspent funds (with restrictions), not Payflex. Instead, they make a small amount per month in administrative fees, and won't "waste" the time needed to process complex claims. As a result, employee funds can be erroneously withheld. One certainty, though, is that I will NEVER sign up for a flexible spending account again.

  • Do
      22nd of Feb, 2016
    0 Votes

    I never had a problem with FSA before 2015. But, United Healthcare never managed my FSA account before 2015 either. What I know now is that if you have an unscrupulous healthcare company managing your FSA account (United Healthcare), you're likely to get fleeced unless you're really on top of your game. Prior to 2015, at my company, we had always been able to carry over FSA expenses into March. This had been the policy for several years. As of 2015, our insurance provider was changed to United Healthcare. They also manage the FSA spending accounts. No information had been provided that this policy had changed. So, by chance at a 2016 benefits meeting in early December, 2015, we found out we'd have to use all of our FSA funds by 12/31/2015. There wasn't much time left. I made as many appointments as I could and filled prescriptions but that wasn't enough. So, I decided to check out the FSA store. They have FSA eligible products clearly identified so I checked them out. I lucked out and found 3 things I really needed and that used the rest of my FSA funds... so I thought.

    United Healthcare denied 90% of the claim with the explanation that I have to provide a note from a physician on how it will treat my diagnosis. In the meantime, they paid for Thermacare heatwraps with no diagnosis from a physician on the same claim. The only difference between the items submitted is that 2 of the 3 were significantly more expensive. All 3 items are on the FSA eligible list without the requirement of a note from my physician.

    It seems obvious to me that the problem here is that you can't allow a party that has a vested financial interest in not paying claims be the arbiter of claim eligibility. My denial just made no sense except that they did not want to pay for the more expensive items. It should not benefit anyone financially to deny these claims. If people have money left over in their account, make them pay taxes on the unused FSA funds. Obviously, stealing people's money is a bit problematic. The experience has certainly changed the way I use it. After 2016, I will evaluate whether there is really any benefit in continuing at all.

  • An
      26th of Jul, 2016
    +1 Votes

    I after years of never joining FSA due the hassle, joined this year as I had trauma care. Oh my gosh, they hassled me for receipts for expenses I already submitted were approved by my physician. So for a month or two, they were reimbursed. Then all of a sudden they start asking you to submit more detailed receipts, from the exact provider. This is a costly service to save $200 a year (assuming you contribute the maximum). This is a waste of government money, my money I pay in taxes everyone year to run this program. It should be abolished as it must cost the government more money to hire incompetent people to audit the expenses we submit. Thank you government for $200.00 tax savings to me after much hassle, and wasting more of my taxes I pay to you to run it. I have been right all along, not worth it.

  • Tr
      5th of Oct, 2016
    0 Votes

    Does anyone know how to contact a person in authority with Wage Works? I enrolled this year as I usually do, and I received my confirmation of enrollment in January and my pay was deducted biweekly as planned. Unfortunately, Wage Works is great about taking my pay, but not at paying me back for my out of pocket medical expenses! I have over $2000 in co-pays, deductibles, etc. from January to August of this year that I have EOBs for and I have not been reimbursed for them! I contacted Wage Works and they said it was the error of my insurance (after being on hold over an hour)! I contacted my insurance and they investigated and they found that Wage Works shows I was not enrolled until Sept. 11, 2016! What?!?! So, my insurance never submitted any EOBs to Wage Works for me to be reimbursed! First off - no one can sign up for anything in the middle of the year! So, why did Wage Works neglect to notify my insurance at the beginning of the year? Wage Works went through a computer system change in September, which must have been how my enrollment kicked in - after their system went back online. But, now I cannot get reimbursed for the previous 8 months of expenses! I have contacted Wage Works 4 more times and they always put me on hold, blame my insurance, employer and anyone else, and the last call they simply hung up on me! So, I tried to contact them via secure messaging and they replied back that I need to call them. So, I am done with them! I want to go above them now to either the OPM or another federal agency that oversees this for federal workers! Does anyone know of contact information for this? There has to be some agency that regulates or oversees what Wage Works does (or doesn't do)! I will never enroll with them again and I am telling anyone I can in the federal government - to NOT enroll!

  • Dx
      2nd of Nov, 2016
    0 Votes

    Wage Works is not the only FSA administrator that is bad. My employer uses PayFlex and I have had numerous disputes with them. I appealed one rejected claim to them and sent them the IRS guidelines which they were in violation of, and they rejected my appeal. I am in the process of appealing to the IRS. Then, because I had so much left over in the account (if the appeal fails) I decided to start buying things that I could use. Their own web site says that compression socks qualify for FSA reimbursement, but they refused to reimburse me. I will never use a flexible spending account again. They are a rip-off.

  • Fr
      4th of Feb, 2017
    0 Votes

    I don't think an agency regulates these fsa providers. I'm convinced employers choose the worst ones out there so they can keep the money you don't use. your employer gets to keep money not the fsa provider. I'm convinced the fsa provider must get a portion of it, that's why they deny everything. I even sent a pic of the item I chose off the fsa store website and still denied it. finally I wrote a short letter where I pasted off the irs website the definition of medical expense. I said I spoke to fsa store and the irs and both authorized. said this was there last chance to put my item in correct category of medical equipment, not special equipment before notifying state and federal officials . I also took a pic off wage works more inclusive items of categories which show no rx or letter is needed for the item I bought . its ridiculous. I included another pic off fsa store . I was going to include the chat notes from the fsa store also if needed where I tricked the fsa rep into telling me the category the item I wished to purchase fell under (medical equipment) then I copied and pasted conversation for later use. . they finally approved it, however they did not change to correct category of medical equipment. They kept it under special equipment which requires a prescription that I do no have because its not needed had it been put in correct category. now I'm wandering if irs is gong to question me over their incompetence. I also submitted shipping under the (other )category due to no option of shipping category, and they changed it to mileage. I bought it online so there was no mileage. I've asked them to correct multiple times but I've been ignore over 15 attempts. does anyone know who regulates these agencies? I rather not be in the middle of an irs dispute, but will f that's what it takes. try submitting it again . mine has an app you can use, so I typed out short irs part, took a pic and sent it first. if its to lengthy they wont read it. will paste below
    I wrote ...you put my item under the wrong category of special equipment and now req a letter. I DO NOT need al ester for medical equipment. this is not special equipment. see pic of my plans policies. these items are determined by irs, IRS ' 213(d)(1), not you. therefore please read this as posted on irs website. its my last attempt before notifying and filing a complaint with irs and state and fed regulators.
    per irs site

    excuse typo's, , , I cannot deal with this crap anymore
    What is medical equipment?
    Medical equipment encompasses a huge range of items designed to be used by account holders to treat a medical condition or monitor its status. Under IRS ' 213(d)(1), "medical care includes amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." this includes medical equipment, supplies and devices. As such, consumer-directed account holders can be fully reimbursed for the purchase of medical equipment with their employee benefits

    if you want to get in writing, go to fsa store and persistently ask questions on the chat popup like, who determines the products on this site. you say its guaranteed, so are you saying irs determines products or your provider? it cant be provider because they couldn't guarantee each item. copy and save conversation before you exit as proof. ask about the item you bought. sure its on site if covered. pasted below. I removed emotes name and changed to fsa store to protect employee of fsa store
    Welcome to FSAstore! How may I help you today?
    ME→Your site says product qualifying for fsa is guaranteed. can I assume everything on site is correct for all non limited fsa products? Are these products determined by IRS medical expenses guidlines, or can each plan or employer choose what qualifies? I know there are limited plans etc, but if you have an FSA which IS NOT a limited fsa, should all product rules be the same? I'm having issues.
    FSA STORE: All of the merchandise on our website is 100% FSA-eligible guaranteed! Please keep in mind that the items listed with a red check do not require a prescription. Items with a blue Rx logo indicate they require a prescription in order to be eligible.
    ME→THAT MEANS NO LETTER ALSO IF ITS A RED CHECK, CORRECT?
    FSA STORE: Correct.
    ME→CATOGORY? PERSONAL ITEM, MEDICAL EQUIPMENT?
    FSA STORE: Pain relief
    ME→MY PLAN DOESNT HAVE A PAIN RELIEF CATEGORY WHEN FILING CLAIMES
    FSA STORE: You can include it under medical equipment
    ME→HOW ABOUT REVIIVE PANEL LIGHT TREATMENT? WANT IT FOR THE INFRARED, BUT PLAN SAYS I NEED A LETTER FROM DR CLAIMING ITS SPECIAL EQUIPENT
    FSA STORE: it is FSA eligible, it's better to contact your FSA plan provider why it is not covered.
    ME→Are these products determined by IRS medical expenses guidelines, or can each plan or employer choose what qualifies? I know there are limited plans etc, but if you have an FSA which IS NOT a limited fsa, should all product rules be the same?
    FSA STORE: I sincerely apologize, we are a specialty store that strictly sells FSA eligible items, Please reach out to your FSA Administrator (the number should be on the back of your card) to find out.
    FSA STORE: All items are guaranteed to be FSA eligible and we work with the IRS and your FSA administrator to make the shopping experience as seamless as possible.
    ME→SO YES THEN, ALL FSA PLANS FOR THE MOST PART COVER THE SAME ITEMS DETERMINED BY IRS NOT THE PLAN HOLDDER LIKE WAGE WORKS FOR EXAMPLE
    ME→I BOUGHT YOUR REVIVE FULL FACE LIGHT THERAPY PANEL AND THEY DENIED IT SAYING I NEED A LETTER BECAUSE ITS CONSIDERED A SPECIAL EQUIPMENT. IM ACTUALLY USING FOR THE RED AND INFRA RED ASPECT.
    FSA STORE: do you have an FSA carad?
    ME→I HAVE AN ACCOUNT, BUT THE WAGEWORKS NEVER PROVIDED ME A CARD, MEVER KNEW THERE WAS ONE AVAIABLE.I HAVE TO ASK BECAUSE WHILE YOU SAY ITS GUARRANTEED, IM BEING ASKED TO PROVIDE A LETTER, WHEN FSA SAYS I DONT NEED RX OR LETTER.I CAN GET ONE, BUT THOSE EARENT THE RULES. SO YOU CANT TELL ME IF ITEMS ARE DETERMINED BY THE IRS, OR DOES EACH PLAN GET TO CHOSE WHAT TO COVER?
    FSA STORE: our items are determined by IRS.
    FSA STORE: But we are not the one who manage your plan.
    FSA STORE: You need to ask your plan administrator why the item is denied.

    ME→THANK U . THEN TELL ME THIS, IS THE REVIVE PANEL BE A SPECIAL EQIPMENT ITEM, ? I THOUGHT THAT WAS HOME MODIFICATIONS ECT.
    FSA STORE: It does not require prescription or letter of medical necessity so not special equipment
    ME→THANK YOU. SAFE TO SAY MOST ITEMS THAT ARE LIKE A MEDICAL DEVICE ON HERE ARE MOSTLY CONSIDERED MEDICAL EQUIPMENT. DOESNT HAVE TO BE JUST DIABETIC STUFF
    FSA STORE :You can ask them for list of items you can purchase using your plan.
    FSA STORE: or better to ask them for an FSA card. .
    ME→LIST ONLY SHOWS CATAGORIES, NOT ITEMS, THEY REFER TO FSA STORE.DOES SAY MEDICAL EQUIOMENT./REPAIRS (DIABETIC MONITOR, ) BUT VAGUE. ON WAGEWORK SITE, AND ON MORE DETAILED PAGE, IT SHOWD MEDICAL EQUPMENT AS COVERED WITH NO RX OR LETTTER NEEDED.
    ME→ DO U THINK MAYBE I SHOULD CONSULT WITH IRS FOR CLARIFICATIONS I CANT GET FROM PROVIDER? Only found file A complaint on IRS site. Guess thats only option. To late to return item now.
    FSA STORE : That would be a good idea to call IRS

  • Fr
      4th of Feb, 2017
    +1 Votes

    by the way, it doesn't matter if you know what your plan rules are, if they wont accept claim, after you have given the a copy of your plan, which you took directly off their website, and still wont put item in correct category and still refuse to reimburse you for it there's really not much you can do. so above where it state s it our responsibility to our plan is not helpful. we know our plan, we know rules, we checked fsa store ect. if fsa provider cant simply look at fsa store they refer us to, its bs. crooks DO NO T EVER DO FSA. RIP OFF. EMPLOYEER KEEPS MONEY.

  • Ma
      2nd of Mar, 2017
    +1 Votes

    In order to file a complaint or question regarding flexible spending accounts, you can contact the US Dept of Labor- Employee Benefits Security Administration. You can file online or contact them at (866)444-EBSA. They overlook health spending accounts.

  • Gd
      6th of Nov, 2017
    +1 Votes

    My company had Tasc for a number of years. They were professional all the way. They had a debit card that would differentiate between allowable and non allowable expenses and not pay non allowed. It was like using your bank card. They switched to PayFlex for 2017 and people started having problems; denials of claims, cards shut down so you can't use them. I still have $1500.00 in account that I may use. Whats worse is that claims that may have been payed get denied then you have to reimburse PayFlex for spending your own money. Then you have to pay the bill again out of your pocket. The companies lead you to believe that the IRS gets left over money. Now that I know the company gets it back I understand what is really happening. They tell you that they changed to save you money however, if Tasc was hassle free they stood less chance of making money off of the programe.

  • Sk
      14th of May, 2018
    0 Votes

    FSA is horrible. I will never give them my money again. They are stealing and incompetent.

  • Da
      13th of Dec, 2018
    0 Votes

    I found out the hard way that flex spending account are frauds. I am a single mom that works one job. I was advised through my benefits department that a flex account would be good for my childcare. I signed up with the First Financial Group of America. This company never contacted me nor sent me any type of information about their company but they faithfully remembered to take my money. I finally contacted the company. Even though this account had never been used or deducted from in 11 months, I find out after contacting them that the account totaled $4800 that they planned to keep. I then questioned their methods. I brought it to their attention that the account had never been used. I also asked about their account managers managing the account but not noticing that the account had not been used. I was informed that they were keeping my money and that it's an IRS rule that says they can. I then scramble to find my daycare receipts. I finally locate a few and send them in because they do not take processed checks from your bank. In the end, they kept $2100 of my money that could have helped my single parent household a great deal. I told the representative that this was a very expensive lesson to learn and that I will manage my own money in my own savings account in the future.

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