Wednesday, December 31, 2008

Not Quite So Flexible

As we speed headlong into 2009, I find myself in a tizzy over unfinished business from 2008.

Namely, my flexible spending account.

I've never had one of these before, but I figured with my monthly prescription co-pays and regular lab tests and check-ups it would be a great way to put aside some tax-free funds for medical expenses.

The FSA can also cover OTC meds like pain reliever or cough drops as well as my contact lens cleaner and solution. What's not to like?

I did a pretty conservative estimate of my monthly expenses, but come end of December I found I was over $150 short of spending my funding.

Not good.

One problem was that I estimated my monthly prescriptions (which could cost about $100/month), but I didn't realize I had a $150 brand name prescription deductible. When I found that out in mid-November, I figured I could wait out the calendar year and just meet the deductible in 2009. No sense in paying the $150 in November then again in January, right?

Unfortunately, I also didn't figure on the lab work I got done in November STILL not being billed or my dental appointment that I squeaked in days before the end of the year being covered 100% with no co-pay.


So, with a week or so left in the year I had two options: get my prescriptions refilled or lose my money.

To do that, I had to overcome two obstacles. One, getting one of my prescriptions credited toward my deductible and two, getting two other prescriptions pre-authorized by my insurance.

I called the pharmacy division of my insurance about both issues. They said my doctor had never submitted a pre-authorization request and they offered to fax the form to her office. This was over a week ago. Then they checked my prescription that hadn't been credited to my deductible and said that I needed to get the pharmacy to re-process it.

I went to the pharmacy to pick up another prescription and asked them to re-submit the claim for the uncredited prescription.

They had no idea how to do that.

Meanwhile, my doctor's office STILL hadn't put through the pre-authorization. I called yesterday and asked them to call the 800 number where they would complete the process while the doctor was on the phone.

Meanwhile, I had given the number of the pharmacy division to my pharmacist and he managed to get my other prescription credited to my deductible. So that makes over $40 applied with less than $110 to go.

No problem.

Unfortunately, there was still no pre-authorization from my doctor's office. I called AGAIN and BEGGED them to call the 800 number. The confused front desk person said they'd already faxed the prescriptions to my pharmacy.

Yes, I said. But they can't FILL the prescriptions without the pre-authorization and for that you need to call the pharmacy division of my insurance!

Now I have the someone from my doctor's office calling me to ask me why I need the Humalog pens and pen needles, how often I use it, etc. I explain it's more portable and easier to use and when you have to inject yourself with insulin 3-5 times a day, anything that makes the process EASIER is a good thing. The doctor's office called back to say they should get a fax as to whether or not the pre-authorization was approved within a half an hour and they'd call to let me know.

They didn't so I called the pharmacy division at 2 pm to see if the pre-authorization had gone through. It had.


Then I went to my pharmacy to pick up my prescriptions. I had the pharmacy assistant run each through in order that the deductible be met with the minimum amount possible. The syringes were $26. The Lantus $86.

That totals $112 and I only need $110. Bingo! This means the pen needles, Humalog pens and One Touch test strips each get filled at the $25 co-pay.

The only problem: the Lantus isn't in stock. Which means my grand total comes to $101. I'm $88 short and there are only 7 hours left in 2008.

I file my claims online to make sure my math is right. I find another $22 spent at that's eligible. And I have a little over $20 in receipts yet to come. (I have until March to complete the claims submission--but the costs need to be incurred by 12/31!)

With the $20, I'm still $46 short. That's $46 of my money that I lose out on. No way that's happening!

I get an idea. I could use a new glucose meter (mine's looking a little battered). They run about $60-80--but they usually come with rebates that make them FREE. Buy a new meter, submit the receipt for reimbursement, meet my FSA requirements and then get the rebate check!

I know--GENIUS!

Although if I could bill the FSA for the time it took to deal with my doctor's office, the pharmacy and my insurance, I'd have had no problem at all reaching that goal!


  1. Somehow we managed to sign up for $80 for the entire year in my husband's FSA. I spent that in like 2 weeks... I know in my FSAs past, I could make claims through March or April. Maybe you can do that on yours??

  2. I called and checked because that would have been an excellent solution to my problem in a have my cake and eat it too kind of way. Unfortunately, while I have until March to submit my claims, I only had until 12/31 to incur the costs.