Q&A Session: Submitting Insurance Claims


Ask the Lawyer received the following question (paraphrased for easier reading and clarity) from a reader on a legal matter that might be of interest to the entire audience.


What can I do if my doctor’s office won’t submit my claim to my insurance company? How does this affect my Flexible Spending Account (FSA) claim? How long does FSA have to process a claim or deny it?


OPM regulations do not directly address the question of what to do if your doctor’s office will not submit a claim to your insurance company, nor does OPM address this issue on the Frequently Asked Questions section of its website. However, OPM suggests that for instance where it does not provide guidance, such as this, you should see your human resources (HR) representative. If your HR rep says he or she doesn’t know, then tell them that OPM’s website directs you to HR.

According to the FSAFED (the flexible spending account for the federal government ) website, “For expenses not covered by your insurance or for expenses that you elect to submit directly to your insurance plan, you must sign the claim form verifying that the expense is not covered and/or has not been reimbursed by FEHB, FEDVIP or any other insurance.”  Visit https://www.fsafeds.com/fsafeds/SummaryOfBenefits.asp#GracePeriod for an explanation.  As to how you will get your money back when you have an outstanding claim, you should also visit your human resources representative for more information.

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