Hi, I originally posted in r/legaladvice and someone mentioned giving this sub a try. Here is the situation:
My employer offers a Flex Spending Account (FSA) and because I have a fair amount of health expenses, I contributed $2500 this year. My work deducts the money from each paycheck. I have been seeing a physical therapist (who is also a licensed massage thereapist) since 2007 for my spinal arthritis. Though my state does not require a doctor’s script to see a PT, I have a script from about 3 years ago. My PT does not take insurance and I pay $130 out of pocket for each visit.
I’ve used my FSA debit card in the past with her with no problem. Recently, our employer switched to a different FSA company. I saw my PT in January, swiped my FSA debit card, and the transaction went through. However, I received a letter from ThrivePass (FSA company) saying I needed to provide a receipt. I did so. Then, I received an e-mail asking for a doctor’s “letter of medical necessity” since my PT is also a massage therapist, they consider it for “general comfort.” Every time I speak with them, they bring up massage and think I am going for massages even though I keep telling them I’m going for PT and that my PT provides both massage services and PT services.
I got my doctor to write a note saying I have Ankylosing Spondylitis (the type of arthritis I have) and that I’ve been seeing Jane Doe, a PT/massage thereapist, since 2007 for my arthritis.
I got an e-mail from ThrivePass saying that my card is suspended. Today I called, and when I spoke to them, they said they had received my doctor’s letter, but because the letter was dated April 5th, it wasn’t valid because I saw the PT in January 2022. The letter clearly states I’ve been seeing her since 2007, but this was not sufficient for them and they want the doctor to have written the note before I saw my PT. I asked how would I have known to ask for a letter prior to seeing my PT when I had no idea it would be rejected? She couldn’t answer that. No where was it stated in any corespondence that the doctor’s note had to predate the date of service for seeing my PT.
I asked to speak to a manager and she called me back earlier today. She said it’s an IRS rule that the medical letter has to predate the date of service for the provider. The more I spoke to her, the more it seemed like it was more of a guideline from the IRS and that this was a company policy. She was this was “to protect me from being audited.” I currently have almost $1700 tied up in my FSA account that I can’t use at all and I told her I’d rather be able to use that money and take the chance of being audited. (And the doctor’s letter states that I’ve been seeing the same PT since 2007, so it does establish that I have been seeing this provider.)
The manager asked me to ask my doctor to change the date of her letter. I expressed concern that this would be some sort of medical fraud, and didn’t understand the logic of breaking one rule to uphold another. It doesn’t seem kosher to me. She also said I could pay the amount back to my FSA, then somehow have the PT refund the card, which I don’t quite understand.
As it stands, my FSA account is still suspended and I can’t use any of my FSA money. (I tried to pay for my bloodwork and it was declined.)
I wanted to know if any of this is legal, and I don’t understand why they denied a very clearly-written doctor’s letter. Where can I go from here?
Any help or insight would be much appreciated. Thank you for your time.
submitted by /u/Lissbirds
[link] [comments]Hi, I originally posted in r/legaladvice and someone mentioned giving this sub a try. Here is the situation: My employer offers a Flex Spending Account (FSA) and because I have a fair amount of health expenses, I contributed $2500 this year. My work deducts the money from each paycheck. I have been seeing a physical therapist (who is also a licensed massage thereapist) since 2007 for my spinal arthritis. Though my state does not require a doctor’s script to see a PT, I have a script from about 3 years ago. My PT does not take insurance and I pay $130 out of pocket for each visit. I’ve used my FSA debit card in the past with her with no problem. Recently, our employer switched to a different FSA company. I saw my PT in January, swiped my FSA debit card, and the transaction went through. However, I received a letter from ThrivePass (FSA company) saying I needed to provide a receipt. I did so. Then, I received an e-mail asking for a doctor’s “letter of medical necessity” since my PT is also a massage therapist, they consider it for “general comfort.” Every time I speak with them, they bring up massage and think I am going for massages even though I keep telling them I’m going for PT and that my PT provides both massage services and PT services. I got my doctor to write a note saying I have Ankylosing Spondylitis (the type of arthritis I have) and that I’ve been seeing Jane Doe, a PT/massage thereapist, since 2007 for my arthritis. I got an e-mail from ThrivePass saying that my card is suspended. Today I called, and when I spoke to them, they said they had received my doctor’s letter, but because the letter was dated April 5th, it wasn’t valid because I saw the PT in January 2022. The letter clearly states I’ve been seeing her since 2007, but this was not sufficient for them and they want the doctor to have written the note before I saw my PT. I asked how would I have known to ask for a letter prior to seeing my PT when I had no idea it would be rejected? She couldn’t answer that. No where was it stated in any corespondence that the doctor’s note had to predate the date of service for seeing my PT. I asked to speak to a manager and she called me back earlier today. She said it’s an IRS rule that the medical letter has to predate the date of service for the provider. The more I spoke to her, the more it seemed like it was more of a guideline from the IRS and that this was a company policy. She was this was “to protect me from being audited.” I currently have almost $1700 tied up in my FSA account that I can’t use at all and I told her I’d rather be able to use that money and take the chance of being audited. (And the doctor’s letter states that I’ve been seeing the same PT since 2007, so it does establish that I have been seeing this provider.) The manager asked me to ask my doctor to change the date of her letter. I expressed concern that this would be some sort of medical fraud, and didn’t understand the logic of breaking one rule to uphold another. It doesn’t seem kosher to me. She also said I could pay the amount back to my FSA, then somehow have the PT refund the card, which I don’t quite understand. As it stands, my FSA account is still suspended and I can’t use any of my FSA money. (I tried to pay for my bloodwork and it was declined.) I wanted to know if any of this is legal, and I don’t understand why they denied a very clearly-written doctor’s letter. Where can I go from here? Any help or insight would be much appreciated. Thank you for your time. submitted by /u/Lissbirds [link] [comments]Read Morer/HealthInsurance