Discovery Benefits, Inc.

Initial Business Response /* (1000, 5, 2015/08/17) */
The participant used a debit card to pay for services in the amount of $48.60 on May 13, 2015. Discovery Benefits emailed to the email address on file for the participant a request for substantiation on May 16, 2015.
A reminder for...

substantiation for the same claim was emailed to the participant at the email address on file on June 14, 2015.
On July 26, 2015, the claim was auto-denied due to the overdue receipt. A Notification of Denied Claims and a Repayment Request were emailed to the participant at the email address on file on July 27, 2015.
Each of these notifications indicates documentation is required and should include an itemized receipt or statement indicating the date of service, type of service and the dollar amount. Because the claim has remained unsubstantiated for more than 72 days, in accordance with IRS regulations, the card has been temporarily suspended until the claim is substantiated, repaid or offset with out-of-pocket expenses. While the card is on hold, the participant still has access to the funds by filing online through the portal or by submitting a manual request for payment as long as the appropriate documentation has been submitted as well.
The participant logged into his account several times between the beginning of June and August 11, 2015. Each of the emailed notifications can be found on the participant's online account as well.
Discovery Benefits received one call from the participant on August 6, 2015.
The participant's debit card will remain in a suspended status until the appropriate documentation is received, the claim has been repaid or the claim has been offset with other out-of-pocket expenses.
Initial Consumer Rebuttal /* (2000, 7, 2015/08/27) */

I am rejecting this response because:
The same day that Discovery Benefits added my dependents to my COBRA plan, they terminated my coverage, stating I hadn't paid the additional amount for the dependents. This is nonsensical and infuriating, as I had been trying to add them to my plan the entire time. How could I pay for their coverage if they weren't on my plan yet? Someone from Discovery Benefits called me and recognized their error. They gave me 24 hours to send the amount for addition of my daughters. I sent a check the same day for about 1800 to cover their addition, back to their birth date in December. I thought that would be the resolution of the issue. However, I called my insurance company to verify my dependent coverage and they said they had not received any communication from Discovery Benefits and my daughters are still not on my plan. I have reached out many times to Discovery to try to add my daughters, paid for their addition, mailed the check the same day, and still do not have coverage for my daughters.

Initial Business Response /* (1000, 12, 2015/06/02) */
Discovery Benefits provides administrative services for the former employer of this participant. Discovery Benefits is not an insurance carrier and does not exercise control over the records of insurance carriers.
Discovery Benefits...

received and processed the election form and initial payment from the participant on May 1, 2015 that included the addition of dependents to the coverage. Dependent information was not provided at the time the participant's information was entered into the employer web portal. According to Discovery Benefits' standard process, the former employer was contacted so that we could confirm the addition of coverage for the dependents.
Discovery Benefits notified the carrier(s) of the reinstatement of benefits for the participant and family on May 4, 2015. Because the dependents needed to be confirmed, no dependent information was passed ** the carrier at that time.
Discovery Benefits received confirmation from the employer to add the dependents. The dependents were added and the carrier(s) notified on May 21, 2015. Discovery Benefits reached out to the participant and provided confirmation of the carrier update on May 21, 2015.

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits does not sell directly to individuals and does not have individual service agreements with...

employees or participants.   Due to the amount of personal information required for a complete response, Discovery Benefits will send a letter directly to the participant and not respond through the Revdex.com.

When a claim is filed for reimbursement, documentation that includes the date of service, type of service, and dollar amount of payment is required for each claim that is filed.  If the documentation provided for each claim does not include this information, the claim will not be able to be approved.  Debit and credit card receipts are not valid documents for substantiating a claim as it does not include all information required by the IRS.  Discovery Benefits processes over a million claims a month.  Systems are automated where possible. We do not refer to previously submitted documentation each time a claim is filed, and it is the responsibility of the participant to submit eligible documentation for each claim, which in this case requires a copy of the contract.  If the participant were to use the debit card for the same amount each month to the same provider, our system would automatically approve those claims without documentation being required – this is because we know by the debit card transaction that payment is being made directly to the provider for a recurring amount. The participant has the following options available to them: use the benefits debit card provided by Discovery Benefits paying the same amount to the same provider for each month’s submission allowing for automatic approval, or submitting a copy of the contract with each manual claim along with documentation that includes the date of service, type of service and dollar amount.

Due to the amount of personal information required to fully respond to the participant, Discovery Benefits will send a response directly to the participant.

The participant contacted Discovery benefits by phone on November 20, 2017 and requested assistance logging into her account.  The Discovery Benefits customer service representative assisted her and stayed on the phone with her until she was able to access her account. According to Discovery Benefits record of system access and phone calls, the participant did not log into her account between November 20, 2017 and April 6, 2018 and Discovery Benefits did not receive any phone calls from the participant between November 20, 2017 and April 6, 2018. Discovery Benefits did receive an email from the participant on November 17, 2017. Discovery Benefits responded with a request for further information to verify the participant on November 21, 2017 and did not receive a response. All communications for the Dependent Care FSA are sent to the participant's email address on her account and are available through the online participant web portal.  Emails notifying the participant that her account statement is available are sent monthly.  Participants have the ability to change or update their notification preferences online at any time.