A S I

It's apparent that this participant does not understand the Benefit he/she are participating in. We are a Third Party Administrator for Benefit Plans sponsored by Employers. The program is governed by IRS rules and we apply those rules when reimbursing participants after
submitting the required documentation. We do not withhold funds from participants and we do not have anything to do with their payroll. The employer sends us a file with elections by employees and upon submitting documentation verifying the medical expense incurred, we reimburse funds to participants. Funds are transferred to us for all reimbursement, we do not hold any funds belonging to participants. Many of our clients offer the debit card to pay for qualified medical expenses and in some instances further documentation is required when we do not have the proper documentation required by the IRS. If the participant does not forward the requested documentation the debit card is suspended until the documentation is received. We send out 3 communications requesting this documentation before the debit card is suspended. Since I don't know who we are talking about I can't be sure this person has a debit card. However, even if the debit card is suspended, they can submit claims request by mail, fax or online. The client has hired us to administer their Benefit Plan according to the law. Again, we do not hold any participants funds and do not benefit by denying any reimbursement. In fact, it's more work for us to deny claims, since we incur additional cost in sending out more correspondence and longer calls from participants. Participants can always talk to a Manager and many times instances such as this are referred to our Manager. *** is not a Salesperson, she is a claims processor trained too properly approve or deny claims payments. Thanks. Tell us why here

Ms*** participates in her Employers' Flexible Benefit Plan. The Plan is regulated by the IRS and thus as contracted by the Employer, we have to administer their Flex Plan according to IRS regulations, to keep their Plan in Compliance with the Law. Since this Plan falls under HIPAA I'm
not able to discuss any detail about what services she has incurred.Ms*** mentions her debit card being funded two days after her receiving the service from her medical provider. The reason being is that her new Plan started (7/1/16) when the card was funded, so the service she received was in her old Plan Year that ended 6/30/16 and funds from the new Plan Year can not pay for services incurred during the old Plan Year per IRS regulations. This has been explained to Ms*** and we referred her back to her medical provider to see if they would change the date on the documentation showing the services were incurred after 7/1/16. Per Ms*** her medical provider will not change the incurred date (probably afraid it might appear like Fraud), so her claim was denied for services claimed outside her current Plan Year.Per IRS rules, the debit card must be suspended if the Participant does not provide proper documentation showing service dates within their Plan Year. Ms*** has spoken to several of our CSR's hoping to get a different answer. Currently we have her account tagged that she can only speak with one of our Manager's. *** ***VP/CFO/COO Tell us why here

Initial Business Response /* (1000, 5, 2015/06/23) */
Contact Name and Title: [redacted] CFO/COO
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@asiflex.com
Her Flexible Benefit Plan is administered under Section 125 of Internal Revenue Code. Per IRS guidelines all expenses incurred and...

requested for reimbursement by a participant, must be verified by 5 pieces of information. They are, name of provider and address, patient name, date of service that was provided, description of service provided and dollar amount owed by participant. If any of these items are missing, then the request for reimbursement will be rejected and proper documentation will be requested by us to complete the processing of their claim.
The use of the Debit Card does not relieve the participant from providing the proper documentation. Under IRS guidelines we can accept payments by the Debit Card, if amounts match co-pays per Employer Health Plans. Since her co-pay didn't match the co-pays in our system it would be automatically rejected. As with her own admission, if the co-pay doesn't match even by $1, it will be rejected by the system, which in her case it was. Again, per IRS guidelines that is what should've occurred since it did not match. Since her Flex Plan is administered under IRS guidelines, the Plan must be administered according to those guidelines or the Employer's Plan risks their Tax-Free status for Employee contributions.
When requesting proper documentation from Ms. [redacted] she has submitted copies of paid receipts, which is not allowed by the IRS (paid receipts only show payment and not any detail of services received). She has also submitted cosmetic expenses which are not allowed by the IRS for reimbursement.
We do not like to reject claims submitted by participants, because it causes more work for us and always try to pay all requests with the information submitted. However, Employers who sponsor these Benefit Plans contract with our Company to administer their Plan according to guidelines as set by the IRS.
Her question about if the expense is coming through a Doctor's office and paid by her Debit Card, why that expense wouldn't be accepted. All payments by the Debit Card are processed by card processing centers and all we see is a payment. It does not tell us what service was provided by the Doctor, Clinic or any other medical provider. Some expense may go through without requiring documentation such as prescriptions.
If Ms. [redacted] would like to talk to one of our Claims Managers for more information on the proper documentation needed when using the Debit Card, she can contact [redacted] or [redacted] at her convenience at our toll free number.

Initial Business Response /* (1000, 7, 2015/12/08) */
Contact Name and Title: [redacted] CFO
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@asiflex.com
Debit card was inactivated/suspended due to lack of documentation as required per IRS regulations for Section 125 Plans that reimburse out of...

pocket medical expenses. The IRS requires that participants submit proper documentation in order to have the reimbursement treated as tax free. Requests for documentation was sent by email on three different occasions(all requests are recorded in our system) from 9/26/14 to 12/11/14. Mr. [redacted] called on 9/8/15 asking why his debit card would not work, he was told due to documentation request not being submitted the card was suspended. He was told what documentation needed to be submitted to verify his expenses and to activate his debit card. All calls are recorded by ASI for accuracy.
Mr. [redacted] called again on 9/9/15 asking again why his debit card was suspended. Again, he was given the information needed to remove his debit card from suspend status. He was told that he had $85.01 dollars left in his Medical Reimbursement account for the Plan Year from 7/1/14-6/30/15, The State of Nebraska has an end date in which claims must be filed to get reimbursed, which was 10/31/15. Since his debit card was suspended and couldn't be used, he was told that he could file a manual claim requesting his remaining funds as long as it was for service dates within his Plan Year as stated above and submitted to ASI by 10/31/15.
Mr. [redacted]'s wife called on 9/10/15 to get information and was told the same information stated above to Mr. [redacted]. She claimed they didn't get any notifications from ASI. Since all notifications go out by email, it was discovered at that point that Mr. [redacted] had changed his email address and never updated his profile with us. Mrs. [redacted] stated that the email we had in our system was his old email address. It is the responsibility of the participant to update any contact information with us.
Mr. [redacted]'s was given ample time and communication from our CSR's on what he needed to do, to get his card reactivated, but failed to do so. As the Claims Processor for his Employer's Plan, we do not hold their funds(we do not collect money from their paychecks) and no funds that are forfeited by Participant's are retained by ASI. Forfeited funds by Participants are retained by his client. We do not like to deny claims, since it creates more work for us, but our clients contract with us, to administer their Employee Benefit Plans according to the Rules and Regulations as detailed by the IRS.

It’s an issue on the providers side (Dentist office). The provider overcharged his card by $22. The provider was to do a refund of the $22 back to the card but instead they charged the card again for $22. So now they need to credit a total of $44 back. I have been in contact with the provider and...

spoke with [redacted](he had given us permission to talk to her back on 10.12.17) one of the office assistants there. After she reviewed the account with me  and I pointed out that on the statement from their office the $22 transaction did not show as a credit but as a charge, at that point she realized they had processed the credit incorrectly. She reached out to the participant (on Monday10/23) because in order to make/correct the transaction they must have the full card number. I contacted [redacted] again this morning because as of this morning there still had been no credit to card. [redacted] state the participant is supposed to contact her today with his card number.  Since all information for this account is covered by HIPAA, authorizations to talk to medical providers is limited to 24 hours.   His FLex funds are available, but use of the debit is limited until all documentation is received by purchases using the debit card.  The card is suspended upon not receiving the documentation as required by the IRS.  Three communications are sent to the participant over 50 days reminding them to submit the documentation.  After the third communication is sent and no response is received by the participant, the card is then suspended.    It appears that the dental office has reached out to their patient to get this settled.