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:
This works - I have been doing it for the last year and it is working out just fine. Get your EOB and keep track of what you owe and what you've paid.
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