A: When you file a claim by mail, the processor must manually enter into the insurance company’s computer system the following information: the treating facility; the facility address; the name of the care provider; ID numbers for the patient, facility and provider; service codes, and the corresponding diagnosis codes. In sum, there is a lot of information that must be entered, which opens the door for errors. For example, we have noticed that insurance company claim processors frequently code the diagnoses checked off on your fee slip from left to right, instead of properly connecting each diagnosis code with its corresponding treatment code. Without logical procedure code/diagnosis pairings, your claim will be automatically rejected. On the other hand, when the Kaplan Clinic files your claim, we do so in your insurance carrier’s preferred format, either electronically or on the “CMS 1500 Form.” Treatment and diagnostic codes are correctly matched and ranked. These claim forms are almost always electronically “read” and automatically processed. The result is that most of the claims we process are decided and paid quickly. Q: I feel like my insurance company is running me ragged with denials and requests for information. I feel overwhelmed! Is there anyone who can help me? A: You can make an appointment with June Guzdowski, the Kaplan Center’s Billing Director, to review your “Explanation of Benefits” (sometimes called a “Remittance Advice”) that your insurance carrier sends to you in response to each claim for reimbursement you submit. June will explain your insurance company’s adjudication, advise you if your claims are being improperly denied and tell you what you can do to appeal the decision. We also can assist you in your appeal for a fee. If you decide this is your best option, we will be happy to give an estimate of the cost of this assistance. There are also patient advocates whom you can hire to help you with your insurance problems. An advocate can be particularly helpful if your situation is very complicated. June can provide you with referrals for these services. FSAs and Nutritional Supplements (including herbal and homeopathic remedies) Q: Does my medical insurance cover the cost of supplements? A: No. The non-‐prescription nutritional supplements and medications that are available for purchase at the Kaplan Clinic are not covered under your insurance company’s prescription plan. Q: Can I get reimbursed for the cost of supplements through my employer-‐sponsored Flexible Spending Account (FSA)? A: Yes -‐-‐ if you have a doctor’s prescription for a supplement, it becomes a reimbursable expense under your Flexible Spending Account (FSA). When you file your claim for FSA reimbursement, remember to submit a copy of your prescription. Q: I used to be able to use my Flexible Spending card to purchase supplements and over-‐the-‐counter cold-‐care products, but now I can’t. Why? A: As of January 1, 2011, patients may not use FSAs to pay for over-‐the-‐counter drugs and medicines unless the patient has a doctor's prescription for the item. The new rule does not apply to items for medical care that are not medicines or drugs. Medical equipment, however, such as crutches, supplies such as bandages, and diagnostic devices such as blood-‐ sugar-‐test kits, still qualify for reimbursement by a health FSA, Health Reimbursement Arrangement (HRA), if purchased after Dec. 31, 2010, regardless of whether the items are purchased using a prescription. Q: How can I get the supplements I purchase at the Kaplan Center to be covered by my FSA Health Reimbursement Account (HRA), Health Savings Account (HSA) or Archer Medical Savings Account (Archer MSA)? A: If you want to submit the cost of your supplements to your FSA, HRA, HSA or Archer MSA, you should ask your physician for a prescription for the products he or she is recommending. Please mention your need for a prescription to your physician during your appointment, prior to purchase. Please submit a copy of your prescription with your reimbursement request.
The IRS rule governing FSAs apply to all tax-‐advantaged health care accounts, including Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs) and Archer Medical Savings Accounts (Archer MSAs).