View Full Version : Flex Accounts and Braces
06-07-2009, 06:58 PM
I am looking for anyone that has had an experience with FSA and braces. My DD is needing braces that will total 5000 OOP. She is needing additional work but thankfully it is being picked up by our medical insurance. Her Dr. is willing to work with us so our flex plan can reimburse us since we are only allowed
3K per year. He is willing to put 1/2 set in Dec 09 and the rest in Jan/Feb. He will bill us separately (2 bills 2500 each). My concern is that flex won't pay. I am wondering if they have problems with this? It is so hard to get a hold of them. I either have to leave a message or email (if mailbox is full)..then it takes over a week for anyone to get back to me.
06-07-2009, 07:10 PM
I do billing for Ortho....so I can tell you that all flex spendings are different. Do you have a card (like a credit card) or do they send you a check? Most flex spendings that send you a check need to see that you actually paid first then they will send you the $$. They will ask for the contract and want to see a down payment and monthly payments. But like I said all are different. PM me if you have any more questions.
06-07-2009, 07:13 PM
My DD got her braces in Jan. 2008 and we went on a monthly payment plan. I send in a receipt to the flex plan every month for the monthly payment and they give me that amount out of my flex account.
Ortho is treated differently since they continue treatment. I put the amount of my monthly payment x 12 when I do my annual flex spending elections.
I'm really surprised that your ortho doesn't offer a payment plan. If he/she does you can do the whole amount through flex.
Hope that helps.
Yes - I know how this works WITH MY EMPLOYER! YMMV with your employer's plan, as well as your payment options offered by your employer.
My DD's orthodontist offers a discount for "upfront" payment. I was advised by our HR department to not do this.
My employer's insurance will pay (up to the plan max of $2500, but also a max of 50%) a 25% downpayment for at the beginning of treatment. And then, they will make a monthly payment of the balance divided by the number of months for the treatment plan.
So - in your case, since i had a 1/2 bottle of wine with dinner, and I do not want to find the calculator, let's say the treatment cost is $4800. (The math works out easier:thumbsup2) and then, we'll say for illustration purposes that the course of treatment will be 18 months.
So - for my example - the downpayment will be $1200. The remaining $3600 will be paid over 18 months at a rate of $200 per month.
With my employer, they will pay $600 from insurance for the downpayment, and my flex will pay the other $600. Then every month, my insurance will pay $100, and my flex will pay $100, until the 18 months of estimated treatment are over.
My employer's flex payments will NOT vary from the above, that simply is due to the plan guidelines. My employer's flex payment plan doesn't care if I paid the rest of it in a lump sum. If I would have paid my DD's treatment in 1 lump sum, they will not reimburse that way. And, if I pay the lump sum in 1 year, and treatment occurs in subsequent years, they will pay per the above "formula" for the first year, and NOTHING for the 2nd year - since I would not have paid anything in subsequent years.
Your employer will most likely have a different payment formula for both insurance and FLEX payments, but it is definitely worth your time to find it out in advance.
If any of the above doesn't make sense, PLEASE let me know. Remember, the above advice is based on wine with dinner:cool1:. My DD had a phase of orthodontia when she was 3 years old ( a quad helix), her first phase of braces when she was in 3rd grade, and is now finishing up phase 2 in about 2 months. WOO HOO! SO - I've had plenty of experience with the insurance and the flex benefits. Her teeth look beautiful right now, so I am glad we did this!
06-07-2009, 07:22 PM
Thank you both. I send in the bill and they direct deposit the money. My ortho does have a payment plan but I know that my flex plan likes to pay a balance. They also will not pay a monthly payment in 2010 for work that was performed in 2009. I also know that I do not need to pay before they reimburse. My DD had ear surgery and we had to pay 1200 of it. I was sent a bill and I then sent it to the flex plan and they deposited the money 5 days later.
06-07-2009, 07:30 PM
Check the details with your employer. We used the flex account with my son's braces and it worked beautifully. Good luck!
06-07-2009, 10:53 PM
I am doing it now. My company has the money put on a visa paid card. Once I had to send in the reciept and what the item was for.
06-07-2009, 11:25 PM
Make sure your plan year starts in January if you are doing this. Ours starts in November, so for us we would have to do Oct for 1/2 a set and Nov for 1/2 a set.
06-07-2009, 11:28 PM
Wow- they all are different! SO weird that this topic comes up as I pay tomorrow!
Our flex plan will reimburse with receipt - no connection to insurance. For our older son, we delayed treatment (only a few months)until the following calendar year so we could put the correct amount in the flex account. We paid the $4000 or so the first week of Jan. and the Flex account paid us back the full amount right away even though they hadn't collected that $ out of my husband pay check yet. Pretty cool.
We goofed on the next one, and only set aside $1000 for this calendar year, and found out all their payment plans would exceed that amount for the rest of 2009. I called them and asked if I paid $1000 tomorrow, could I pay off the balance Jan. 2010 and call it good. They agreed - they'll get the money sooner this way, but will receive a little less in 2009.
06-08-2009, 12:32 AM
They also will not pay a monthly payment in 2010 for work that was performed in 2009.
You might want to double check this. With our plan, we have until March 31st of the following calendar year to submit claims for the previous year.
Again, every plan is different.
06-08-2009, 09:12 AM
This is out first year having a fsa account. I cannot believe I didnt use it years ago.
I only put $800 into it and than found in February my one daughter needed oral surgery and $2800 worth of orthodontist treatment that the insurance wont cover. Grrr I f I would of known earlier I would of put more into it.
Between ER visits this spring I had $500 left on my flex card. I put that down on the treatment along with another $600. I have to pay $200 a months for 10 months. Since its on going treatment for a total of 12 months I can pay next year with next years funds on those monthly payment. So at least 4 out of my 10 payments will be in 2010.
06-08-2009, 10:42 AM
My employer uses Payflex for their FSAs, and I've had nothing but good experiences with them. I have braces now, and I paid the total amount up front ($3800) because I got a discount with the orthodontist. I got my braces in January of 2007, and as soon as I paid for them, I put in for reimbursement and they sent a check to me immediately, even though it was the beginning of the year and my payroll deductions did not cover the whole amount yet.
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