EMPLOYEES MAY need to do a simultaneous “two-step” toward receiving reimbursement for medical insurance claims. Do not go step-by-step, because that can result in loss of flexible spending dollars.
KATIE ROSS, Human Resources Administration director for the University of Illinois, reports continued delays in State reimbursements.
STATE FINANCIAL problems, with no end in sight, have caused significant delays in reimbursing health-care providers—who in turn delay reimbursing UIC employees for medical claims that they might have been required to pay upfront at the time of service. Further, Ross reported, “If employees wait until their medical claim payment is received before submitting their Flexible Spending Account (FSA)/Medical Care Assistance Plan (MCAP) claim for reimbursement, then they will risk submitting the FSA claim (claims incurred July 1, 2013 through September 15, 2014) after September 30, 2014, which is the end of the run-out period, in other words the ‘use it or lose it’ date.”
HOWEVER, EMPLOYEES can work around part of that delay to avoid losing their FSA money. Rather than waiting for the State and insurers, go ahead and file with your FSA/MCAP to recover out-of-pocket expenses, said Kathleen Stauffer, Assistant Dean for Administration in UIC’s College of Urban Planning and Public Affairs.
Ross reminds employees that they need to have a copy of their health plan claim determination or Explanation of Benefits (EOB) from their service provider to submit to WageWorksâ, the FSA administrator, so that WageWorksâ knows what amount insurance is going to pay and what amount the employee will owe.
HERE’S HOW Stauffer does it. When she gets an Explanation of Benefits from CIGNA, her insurance carrier, she prints it out and sends it in with a claim to her FSA/MCAP plan. (The FSA/MCAP reduces your taxable income by allowing you to set aside a portion of your income for medical claim reimbursements.)
“THEY PRETTY much reimburse you right away,” Stauffer said. “You don’t have to wait.” You do not have to risk losing money; if you wait too long to submit to a flexible spending account, however, you may be past the time limit to be reimbursed.
“THE DELAY in payment of Quality Care Health Plan (QCHP) and Quality Care Dental Plan (QCDP) claims by the State is an ongoing issue,” Ross said.
“SOME OF us are waiting three years for the State to pay our providers,” Stauffer said. “I have never waited for the State to actually pay before filing” with a Flexible Spending Account. “Otherwise, I too would have lost money.”
ON AUG. 8, 2013, the Illinois Department of Central Management Services (CMS) reported health claims were backlogged ten to 14 months. Claims processed through Oct. 22, 2012, had been released to QCHP-contracted providers. Claims processed through June 18, 2012, had been released to non-QCHP-contracted providers.
THOUGH THE stalls are mostly unabated, Ross tells of one bright light. “We have seen improvement, somewhat, in payment of dental claims,” she said. “The Non-Network dental claims are down to a 25-week delay now, as opposed to a 45-week delay on July 1. The shortest wait would be for using an In-Network dental provider, with a delay currently running about 11 weeks.”
FOR HELP if your healthcare provider is asking for payment in full upfront for major services you cannot afford, such as surgery, contact CMS by email at CMS.WebsiteBenefits@illinois.gov or call (217) 558-4486.
FOR INFORMATION on QCHP and QCDP claims payments being released:
A BLOG from March has more information, which Ross said has not changed much: