EOB Requirements for Medical FSA Reimbursement

Texas

We administer our FSA's in-house. I have always paid claims if given a doctor's bill for the date of service, showing both the patient name and charges for the day. Recently an employee turned in a claim and she was reimbursed for her payment. Later she told me that insurance paid part of that claim so she owed us a refund. Luckily, she turned in another claim that was greater than the overpayment so we worked it out. Since then I have required employees to furnish an EOB. Do we have to require an EOB for co-pays? Thanks for your help!

FunHRBanker

Our TPA requires the EOB rather than a doctor's statement. That way, they can see everything they need (patient name, date of service, amount allowed, etc.). To be safe, I'd say yes, require the EOB.

stilldazed

Unless you have something different in your SPD, what you can accept is the same as what IRS would require if the person were filing the expenses on income tax returns. Hopefully, if you do have something different in your SPD, it is not more restrictive than IRS. I don't recall the IRS publication number, but I have reviewed it numerous times and have found it without difficulty at the IRS web site. We in-house our FSA as well, and I get the pleasure of troubleshooting issues sometimes. Reading through the publication is a little tedious because it is written for the taxpayer & not the employer.

best wishes

dbutton111

We require EOBs for everything other than regular co-pays.