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Employee Benefits Corporation Reviews (20)

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below [To assist us in bringing this matter to a close, we would like to know your view on the matter.] Regards, [redacted] WOW they didnt respond to Revdex.com in a timely matter! I have place seperate calls to EBCFLEX and none of which have an answer regarding my claimAll they say is that they are working on my appealI have requested to speak with [redacted] *, however all I get is her voicemailI have a son, and he needs to be seen at the doctor's office, I have foot therapies that were scheduled and canceled and I need to attend those doctor's appointments; I refuse to come out of pocket for money that I do not oweIf this company had it together, they should not let this linger on from Feb But I guess, since they were presenting information, it would take some time to put things in perspective.It shouldn't be this hard to get a response from April 13th Thank you [redacted] ***

Good Afternoon: Ms [redacted] forwarded the requested documentation from her physician to Employee Benefits Corporation to aid in the substantiation of her claim Unfortunately, the letter from her physician does not contain the information necessary to approve the claim The letter from her physician does not provide a specific medical diagnosis, nor does it indicate these specific shoes are required to treat her medical condition The letter does not also say that the specific shoes Ms [redacted] purchased or orthopedic shoes We have two options at this point The first option is for Ms [redacted] to have her physician resubmit the letter of medical necessity If she chooses this option, it may be helpful for her physician to complete and sign the form we provided in our last correspondence The letter we did receive from her physician was missing key information, and our Letter of Medical Necessity form would provide the outline for the specific information we are looking for The second option is to have a third party independently review the claim This is an option listed in her Summary Plan Description Under the Patient Protection and Affordable Care Act of (PPACA), there are standards set forth for plans and issuers regarding both internal claims and appeals process and external reviewPPACA implemented consumer protection standards for an external review of adverse benefit determinations based on medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered benefit The external review process is conducted by an accredited Independent Review Organization (IRO) We would submit all claims documentation to the IRO, including the correspondence between Ms [redacted] and Employee Benefits Corporation Ms [redacted] would be allowed to submit additional information in writing that the IRO will consider when conducting the external review The IRO’s decision is binding on Ms [redacted] as well as Employee Benefits Corporation The IRO will provide written notice of its decision to uphold or reverse the adverse benefit determination within no more than days after the receipt of the request for external review Please let us know how Ms [redacted] would like to proceed

I would give them a zero rating if I could.

Their customer service rep was horrible and rude to me, and kept saying "it's in the email", instead of explaining the answers to my questions.

They never responded to my letter about the situation.

Despite seeing the SAME doctor each month, they ALWAYS require documentation for that doctor, which is a pain to procure, as my insurance takes forever to process the claim. Even when I submit documentation that was previously accepted for past month, this company says I have to submit more.

They are horrible, and I would never use them unless forced.

I have had the opportunity to investigate the complaint that Mr*** *** filed with the Revdex.com on January 15, We do take this complaint very seriously and thank you for the opportunity to share our perspective of this situationEmployee Benefits Corporation provides
services to assist employers with complying with COBRA notice requirements, communicating coverage changes to insurance companies, and facilitating payments that are made by participantsMr*** enrolled in the Coserve Global Solutions COBRA continuation plan on November 8, for the coverage period beginning on October 12, Mr***’s coverage is for months as long as he remains eligibleIn the initial notice that Mr*** received dated October 25, 2017, it was explained that the premium amount that he was given at the time he elected coverage could change in the future due to changes made in the underlying group health plansCoserve Global Solutions changed insurance carriers from Aetna Health to Blue Cross Blue Shield effective January 1, The change notification was mailed to Mr*** on December 27, The change notification outlined who the new insurance carrier was and that the premiums would be $788.00, resulting in an increase of $per month. The insurance premiums were increased due to Coserve Global Solutions changing the health insurance plan offered to their employees. Employee Benefits Corporation did send all of the appropriate notices to Mr*** on behalf of Coserve Global Solutions and sent the correct information to both Aetna and Blue Cross Blue Shield to process the insurance carrier change There was a delay in processing the enrollment by Blue Cross Blue Shield and this has led to Mr***’s experience and perception of not having coverageBlue Cross Blue Shield to date has not processed the information from Coserve Global Solutions so Mr*** is not appearing as active in their systemCoserve Global Solutions is working directly with Blue Cross Blue Shield has received confirmation that the issue should be resolved by Friday, January 19, Although Mr*** has not had a positive experience being able to use his insurance, his insurance will be retroactive to January 1, 2018. If Mr*** has incurred any out of pocket expenses that should be covered insurance, he can submit them to Blue Cross Blue Shield as soon as the processing issues are resolvedI can appreciate that this has not been a good experience for Mr*** and we are working with his former employer to resolve this situation as soon as possible. The Supervisor of our Participant Services team reached out to Mr*** on January 17, to make sure that we address all of his concerns and to assure him that he has not gone without coverage since he has elected coverage in October We will continue to work directly with Mr*** until the coverage is verified active in the Blue Cross Blue Shield system and answer any additional questions that he hasTell us why here

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Please have employee benefit Corporation provide the policy number and proof of insurance and the effective date of Blue Cross Blue Shield insurance currently today I am in paying for Blue Cross Blue Shield since January one and I still do not have a policy number or an insurance card or any means to claim anything on that insurance
Regards,
[redacted]

I have had the opportunity to review the circumstances surrounding
the complaint that Mr. [redacted] filed with the Revdex.com...

on December
4, 2014, against Employee Benefits Corporation. We do take this complaint very
seriously and thank you for the opportunity to share our perspective of this
situation.
Mr. [redacted] manages the flexible spending account on behalf of
his company, Working Partnerships and he has been a client of Employee Benefits
Corporation for a number of years.  Our
communication with Mr. [redacted] began in March 2014, regarding the funding
of the Health Care Flexible Spending Account for his plan participants.    To help
understand the situation, I would like to provide some background.  Under a Section 125 Flexible Spending
Account, IRS Regulations require that a participant have access to the full annual
election in their Health Care FSA on the first day of the plan year, regardless
of whether the funds have been payroll deducted.  The employer divides the annual election by
the number of paychecks and deducts money out of each paycheck. 
Employee
Benefits Corporation generates a payroll invoice either per payroll or monthly,
which the employer should use to match against the deductions they are taking
out of each employee’s paycheck.  On the debit
date listed on the invoice, Employee Benefits Corporation debits those funds
from an employer’s account.  Those funds
are used to pay claims.   
When
a participant submits a claim larger than the balance an employer has deposited,
we generate a “Medical Excess” Invoice.  This
is necessary so that we can reimburse plan participants in a timely
manner.  When an employer experiences
this situation, they can either choose to pay the Medical Excess Invoice or by paying their next payroll
invoice in advance if there is
enough money to cover the expenses indicated on the Medical Excess
Invoice.  In this case, the employer’s
next payroll invoice did not cover the expense so the employer owed the Medical
Excess Invoice.  The employer did not
authorize Employee Benefits Corporation to automatically auto debit the Medical
Excess Invoice, so the employer would pay this particular invoice via
check.  Next, depending on how the
employer directs us, we will either continue taking the regular debit for the
payroll invoice or at the employer’s direction, we will not debit specific
payroll invoices.  At the end of the plan
year, or the employer may request it earlier, we will issue a refund for any
additional funds paid in above the employee elections,
In
the agreement that Working Partnerships signed, under the section labeled
“Responsibilities of the Employer” it is established that “The employer shall
provide Employee Benefits Corporation with all funds that Employee Benefits
Corporation needs to pay benefit claims under the plan if FSAs are elected. If
Employee Benefits Corporation receives qualified benefit claims in excess of
the corresponding funds from the employer, the employer shall provide the funds
to Employee Benefits Corporation within 2 days of notice of such request by
Employee Benefits Corporation.”
For
the 2014 plan year, Working Partnerships had one plan participant enrolled in
the Health Care FSA. The participant submitted a claim in the amount of $1,158.50
on March 17, 2014. At the time the claim was processed and approved, Employee
Benefits Corporation had only collected payroll deposits in the amount of
$266.64.  We generated a Medical Excess
Invoice to Working Partnerships on March 18, 2014 in the amount of $891.86.   This invoice was not paid and since that
time, there has been ongoing communication between Mr. [redacted] and Employee
Benefits Corporation.  To summarize, Mr. [redacted]
has expressed these concerns:
·        
The
amount of money Employee Benefits Corporation debited from Working Partnerships
does not reconcile with the amount that has been deducted from employee’s
paychecks. 
 
·        
When
a participant makes a claim for an amount greater than what Working
Partnerships has deposited, Working Partnerships would like Employee Benefits
Corporation to advance the funds out of their own account
·        
Mr.
[redacted] would like a full refund of the 2014 administrative fees
·        
Mr.
[redacted] would like to terminate the plan December 31, 2014 without the 90
day run out. 
To
address the concerns, we have taken the following action:
·        
Mr.
[redacted] requested documentation of all funds that were withdrawn from their
account for the plan.
o   Working Partnerships has one
employee in the plan, who elected $1,599.84 for the plan year of 1/1/2014 –
12/31/2014. 
o   Working Partnerships deducts
$66.66 from each paycheck, and the participant is paid two times per month
o   To date, Employee Benefits
Corporation debited $1,466.52 from Working Partnerships Account and the details
are listed below
o   When Working Partnerships makes
the final two payroll deduction payments of $133.32, the plan will be whole and
the participant will be paid.
o   Employee Benefits Corporation
received an additional payment in June 2014 for $50.  Working Partnerships monthly administrative
fees are $50 so we refunded the $50.  We
did not apply the funds to the payroll invoice because we do not co-mingle the
funds between administrative costs and payroll deductions amounts. 
o   Working Partnerships will owe one
more month of administrative fees for $50 and that invoice will generate on
December 15, 2014
 

 
 
·        
Mr.
[redacted] asked Employee Benefits Corporation to advance the funds on behalf
of Working Partnerships to pay his employee’s claims. 
o   Working Partnerships contract
with Employee Benefits Corporation clearly states “The Employer shall provide
EBC with all funds that EBC needs to pay benefit claims under the Plan if FSAs
are elected.  If EBC receives qualified
benefit claims in excess of the corresponding funds from the Employer, the
Employer shall provide funds to EBC within two (2) days of such request by
EBC. 
o   The Plan Document
establishes that the funds of the plan are the general assets of the employer
as outlined in Section 9.3 of the plan document.  If Employee Benefits
Corporation advances money to pay for claims, these funds would not be general
assets of the employer.
o   In the Plan Document, under
Section 9.3 Funding the Plan, which is part of the agreement with the employer,
it states:  “All
benefits payable under the Plan shall be paid from the general assets of the
Employer or from policies of insurance purchased under the Plan. No funds are
required to be set aside for the payment of benefits. To the extent any funds
are set aside, they shall be subject to claims of general creditors of the
Employer. Funds held by a third party administrator or service provider, such
as Employee Benefits Corporation, for the payment of benefits under the Plan
shall be assets of the Employer, subject to claims of general creditors of the Employer.”
o   Although other TPAs may advance
funds, their interpretation of the regulations is different and that is why Employee
Benefits Corporation does not advance funds. 
The guidelines state   the dollars maintained
in the Health Care FSA are deemed to be plan assets and must comply with
ERISA’s plan asset rules.  Generally, plan assets trigger ERISA’s trust
and exclusive benefit rules.  However, there is a safe harbor in DOL
Technical Release 92-01 that does not require the employer to establish a trust
and complete all of the filing requirements if the reimbursements are paid from
the plan assets of the employer.  
o   Under the terms of
the agreement, Mr. [redacted]
should have paid the Medical Excess Invoice within two business days of the
notice that was generated on March 18, 2014.
 
There are specific IRS regulations surrounding the plan that we
must adhere to in order to keep the plan compliant, and we did try to resolve the issue via
telephone instead of email to come to a mutual understanding and Mr. [redacted]
would not take or return our telephone calls. 
 At Mr.
[redacted]’s request, we terminated his plan December 31, 2014 without the 90
day run out.  Because we have
administered the plan according to the terms of the contract and we have made
several attempts to work collaboratively to resolve this situation, we will not
issue a refund for services. 
Please feel free to contact me if you need any further details
about this case.
 
 








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We certainly understand the frustration that Mr. [redacted] has experienced and have demonstrated our care in our diligent work on his behalf to ensure his coverage is reinstated properly. Employee Benefits Corporation, however, in our specific role facilitating the processing of paperwork and payments related to coverage on behalf of Mr. [redacted]’s former employer, does not and cannot take action on behalf of Blue Cross Blue Shield of Georgia. Unfortunately that means that we have no way to obtain the information that Mr. [redacted] is requesting until Blue Cross Blue Shield of Georgia processes the enrollment for Mr. [redacted]’s plan and releases that information to us for his former employer’s records. Until that happens, the only way for Mr. [redacted] to obtain any information about his coverage is to reach out directly to Blue Cross Blue Shield of GA. Their number is ###-###-####. Employee Benefits Corporation is continuing to advocate for Mr. [redacted] to have Blue Cross Blue Shield of GA activate his insurance as quickly as possible, and our Participant Services Supervisor will continue to follow up with Mr. [redacted] to update him as new information is made available to us by Blue Cross Blue Shield of GA.

We are in receipt of the inquiry from [redacted] regarding the claims payment out of her husband's EBC HRA plan.  We appreciate the opportunity to provide further clarification on this matter.  After reviewing the claims that were submitted and the date that they were submitted, we...

reached out to Mr. [redacted]'s employer to discuss the matter.  Mr. [redacted]’s employer has updated their plan to extend the timeframe to submit claims and as a result, we have reprocessed those claims and the remaining 2015 account balance of $397.22 should pay out in the next week to ten days.I also reached out to Ms. [redacted] to discuss the situation and am working with her directly on some other questions that she has regarding her account.  I apologize for the inconvenience we have caused Ms. [redacted] and believe that we have resolved this situation to her satisfaction.  If you have any questions, please contact me at ###-###-####.Sincerely, [redacted]Executive Vice President of Operations

Thank you for bringing this complaint to our attention.  We will look into this situation and provide a response within the next few days. [redacted]

Ms. [redacted]:I would like to apologize for the service that you received from our organization.  Upon receiving your complaint with the Revdex.com I called you to discuss this issue and left you a voice mail message.  Another representative from my company, Lisa Sauer, also...

called you and left a message earlier today.  I would really appreciate the opportunity to speak to you directly to answer your questions and discuss the service issues that you experienced.   I will call you again tomorrow morning to answer your questions and help you in any way that I can.  Sincerely,[redacted]
[redacted]###-###-#######-###-####, ext. [redacted]

I have had the opportunity to investigate the complaint that Ms. [redacted] filed with the Revdex.com on March 13, 2015 against Employee Benefits Corporation. We do take this complaint very seriously and thank you for the opportunity to share our perspective of this...

situation. Ms. [redacted]’s employer selected Employee Benefits Corporation to administer the Section 125 plan for their employees this year and Ms. [redacted] elected to participate in the Health Care Flexible Spending Account.  A Health Care Flexible Spending Account (FSA) allows employees to be reimbursed for IRS approved eligible medical expenses through voluntary pre-tax payroll deductions As the administrator of this plan we offer the use of a debit card.  This debit card can be used as a convenience to reimburse participants in a Health Care FSA for eligible medical expenses without having to use out of pocket funds.  If the use of these cards meets certain IRS approved substantiation methods, participants may not have to provide additional information to the Health Care FSA benefit administrator.  When these transactions do not meet the substantiation requirements as FSA eligible expenses, plan administrators must then request documentation from the participant for the expense in question.  The documentation is pertinent in determining if the expense qualifies under the plan and complies with the IRS regulations for the use of these pre-taxed dollars.   In this situation, Ms. [redacted] purchased six pair of shoes in three separate transactions.  Employee Benefits Corporation requested that Ms. [redacted] submit the receipts so that we could verify the expense was for orthopedic shoes.  Under the IRS guidelines, orthopedic shoes are shoes that are custom made to treat or alleviate a medical condition or defect.  These types of shoes cannot be purchased at a regular shoe store or purchased “off the shelf.” The excess cost above and beyond the normal cost of shoes is the eligible medical expense. Employee Benefits Corporation uses a standard amount of $50.00 as the cost of a normal shoe. To assure that we have documentation that the shoes are orthopedic shoes, the participant is encouraged to submit a letter of medical necessity for the shoes with their claim for reimbursement. Regular shoes are not eligible under a Section 125 plan. When Ms. [redacted] submitted her receipts, there was no documentation supporting that these were orthopedic shoes.  Our Participant Service Representatives spoke with Ms. [redacted] on February 18, 2015 and February 20, 2015, after Ms. [redacted] received the repayment notification from Employee Benefits Corporation, stating the shoes were ineligible and she must repay the plan or provide appropriate documentation.  When speaking with Ms. [redacted], the Participant Services Representative did inform Ms. [redacted] that because the substantiation did not indicate the shoes were orthopedic footwear, in order to be considered eligible, she would need to obtain a letter of medical necessity from her physician that these shoes are in fact orthopedic shoes and required to treat her specific medical condition.  This documentation is required based on the IRS guidance on substantiating this type of expense.  To date, Employee Benefits Corporation has not received the requested documentation from Ms. [redacted].  The use of Ms. [redacted]’s debit card has been suspended until she provides the appropriate documentation or repays the plan.  The IRS requires that a debit card be suspended when there are unsubstantiated transactions.  Once this is resolved, her debit card will be un-suspended and will be available for use for other eligible medical expenses. Although Footsmart.com has a designated medical eligible merchant category code that allows for flex card transactions, very few of the items that they sell are eligible under a Section 125 plan.  Footsmart.com is not a company we own or partner with, nor do we have control over what they display on their website as items that are eligible for FSA reimbursement.  We are currently reviewing this company and whether expenses will be authorized with our debit card given that most of the items are ineligible.  I do not believe that Employee Benefits Corporation has done anything that would warrant such a complaint filed against us, and we would appreciate Ms. [redacted] either submit appropriate documentation or repay her plan.  Please feel free to contact me if you need any further details about this case.

Good Afternoon:
 
Ms. [redacted] forwarded the requested documentation from her physician
to Employee Benefits Corporation to aid in the substantiation of her
claim.  Unfortunately, the letter from her physician does not contain the
information necessary to approve the claim.  The letter from her physician
does not provide a specific medical diagnosis, nor does it indicate these
specific shoes are required to treat her medical condition.  The letter
does not also say that the specific shoes Ms. [redacted] purchased or orthopedic
shoes.  We have two options at this point.  The first option is for
Ms. [redacted] to have her physician resubmit the letter of medical necessity. 
If she chooses this option, it may be helpful for her physician to complete and
sign the form we provided in our last correspondence.  The letter we did
receive from her physician was missing key information, and our Letter of
Medical Necessity form would provide the outline for the specific information
we are looking for. 
 
The second option is to have a third party independently review
the claim.  This is an option listed in her Summary Plan
Description.   Under the Patient Protection and Affordable Care Act
of 2010 (PPACA), there are standards set forth for plans and issuers regarding
both internal claims and appeals process and external review. PPACA implemented
consumer protection standards for an external review of adverse benefit
determinations based on medical necessity, appropriateness, health care
setting, level of care, or effectiveness of a covered benefit.  The
external review process is conducted by an accredited Independent Review
Organization (IRO).  We would submit all claims documentation to the IRO,
including the correspondence between Ms. [redacted] and Employee Benefits
Corporation.  Ms. [redacted] would be allowed to submit additional information
in writing that the IRO will consider when conducting the external
review.  The IRO’s decision is binding on Ms. [redacted] as well as Employee
Benefits Corporation.  The IRO will provide written notice of its decision
to uphold or reverse the adverse benefit determination within no more than 45
days after the receipt of the request for external review.  Please let us
know how Ms. [redacted] would like to proceed.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]   WOW they didnt respond to Revdex.com in a timely matter! I have place 3 seperate calls to EBCFLEX and none of which have an answer regarding my claim. All they say is that they are working on my appeal. I have requested to speak with [redacted], however all I get is her voicemail. I have a son, and he needs to be seen at the doctor's office, I have foot therapies that were scheduled and canceled and I need to attend those doctor's appointments; I refuse to come out of pocket for money that I do not owe. If this company had it together, they should not let this linger on from Feb 2015. But I guess, since they were presenting false information, it would take some time to put things in perspective.It shouldn't be this hard to get a response from April 13th.  Thank you[redacted]

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  I am still working with EBC to resolve all matters regarding our account. 
Regards,
[redacted]

Review: Our employer decided to go with another provider this year, and it was the flex card-Employee benefits Corporation. I took that plan with my employer that they match what we put in. So this year, I am putting in $1000. and my employer will put in the same; which totals $2000. on my bennycard account.

As with previous purchases, I always shop at Footsmart for my Achilles tendonitis issues. Well this year, since we are with our new "Bennycard" they have denied my claims for Footsmart. Their answer to me was the IRS didn't approve my claim, and if I have foot problems I need a doctor note to specifically create and design my shoes for my feet. I explained to them that on their website that they have a list of all services covered and 'Orthopedic shoes' was an option. I advised to them if there was footnotes that needed to be disclosed on their website to let consumers know their boundaries. There is no asterisk or footnotes disclosing this information at all. They just verbally told me I was denied and needed to repay this amount back. I am currently looking into legal assistance to see what my rights are as a consumer.

I am disputing this repayment due to fact that their are other employees that have been approved from the same provider-Footsmart. It's like they 'cherry picked' who they was going to approve and who they were going to deny. ALL FSA cards have a coded system. If I go to Wal[redacted]s and buy toilet paper, napkins, milk and bandages. I can use my card; however it will pay for my bandages, and I have to supply another form of payment for my other items. This is how it is suppose to work. I cannot take my card and buy shoes at Kohl's department store. Footsmart is a FSA provider (they say on their website Orthopedic shoes) they have the FSA code for my card. If I purchase a pair of shoes, and then foot cream, the foot cream is denied, but the shoes are paid for-this makes sense-since its a approved FSA provider. So if EBC is denying my claims, then they need to change/or block their FSA code so that people should not use that company. Their website does not disclose any exceptions and this is not fair to the consumer. When I spoke with a representative she stated that they do not have this information disclosed to the consumer and that might be an option for the future. I told her that this needs to be addressed today not in the future.

So, at the end of the conversation I stated will the money that I have put in for year-to-date should cover charges since they have denied my orthopedic shoes. They told me I needed to send a money order or check and they will un suspended my account to use my card again.Desired Settlement: 1. I need them to un suspend my account and release my funds back to my card.

2. They need to have disclosures on what is approved and not approved on their website. The website of what is covered has no footnotes or exceptions or asterisks on what is not covered.

3. They need to change their bennycard coding so that certain merchants/and or merchandise DO NOT approve through the card if they are not willing to pay for it. Footsmart IS A FSA provider and this is why the original claims went through and now a dispute. Consumers will

Business

Response:

I have had the opportunity to investigate the complaint that Ms. [redacted] filed with the Revdex.com on March 13, 2015 against Employee Benefits Corporation. We do take this complaint very seriously and thank you for the opportunity to share our perspective of this situation. Ms. [redacted]’s employer selected Employee Benefits Corporation to administer the Section 125 plan for their employees this year and Ms. [redacted] elected to participate in the Health Care Flexible Spending Account. A Health Care Flexible Spending Account (FSA) allows employees to be reimbursed for IRS approved eligible medical expenses through voluntary pre-tax payroll deductions As the administrator of this plan we offer the use of a debit card. This debit card can be used as a convenience to reimburse participants in a Health Care FSA for eligible medical expenses without having to use out of pocket funds. If the use of these cards meets certain IRS approved substantiation methods, participants may not have to provide additional information to the Health Care FSA benefit administrator. When these transactions do not meet the substantiation requirements as FSA eligible expenses, plan administrators must then request documentation from the participant for the expense in question. The documentation is pertinent in determining if the expense qualifies under the plan and complies with the IRS regulations for the use of these pre-taxed dollars. In this situation, Ms. [redacted] purchased six pair of shoes in three separate transactions. Employee Benefits Corporation requested that Ms. [redacted] submit the receipts so that we could verify the expense was for orthopedic shoes. Under the IRS guidelines, orthopedic shoes are shoes that are custom made to treat or alleviate a medical condition or defect. These types of shoes cannot be purchased at a regular shoe store or purchased “off the shelf.” The excess cost above and beyond the normal cost of shoes is the eligible medical expense. Employee Benefits Corporation uses a standard amount of $50.00 as the cost of a normal shoe. To assure that we have documentation that the shoes are orthopedic shoes, the participant is encouraged to submit a letter of medical necessity for the shoes with their claim for reimbursement. Regular shoes are not eligible under a Section 125 plan. When Ms. [redacted] submitted her receipts, there was no documentation supporting that these were orthopedic shoes. Our Participant Service Representatives spoke with Ms. [redacted] on February 18, 2015 and February 20, 2015, after Ms. [redacted] received the repayment notification from Employee Benefits Corporation, stating the shoes were ineligible and she must repay the plan or provide appropriate documentation. When speaking with Ms. [redacted], the Participant Services Representative did inform Ms. [redacted] that because the substantiation did not indicate the shoes were orthopedic footwear, in order to be considered eligible, she would need to obtain a letter of medical necessity from her physician that these shoes are in fact orthopedic shoes and required to treat her specific medical condition. This documentation is required based on the IRS guidance on substantiating this type of expense. To date, Employee Benefits Corporation has not received the requested documentation from Ms. [redacted]. The use of Ms. [redacted]’s debit card has been suspended until she provides the appropriate documentation or repays the plan. The IRS requires that a debit card be suspended when there are unsubstantiated transactions. Once this is resolved, her debit card will be un-suspended and will be available for use for other eligible medical expenses. Although Footsmart.com has a designated medical eligible merchant category code that allows for flex card transactions, very few of the items that they sell are eligible under a Section 125 plan. Footsmart.com is not a company we own or partner with, nor do we have control over what they display on their website as items that are eligible for FSA reimbursement. We are currently reviewing this company and whether expenses will be authorized with our debit card given that most of the items are ineligible. I do not believe that Employee Benefits Corporation has done anything that would warrant such a complaint filed against us, and we would appreciate Ms. [redacted] either submit appropriate documentation or repay her plan. Please feel free to contact me if you need any further details about this case.

Business

Response:

Good Afternoon:

Ms. [redacted] forwarded the requested documentation from her physician

to Employee Benefits Corporation to aid in the substantiation of her

claim. Unfortunately, the letter from her physician does not contain the

information necessary to approve the claim. The letter from her physician

does not provide a specific medical diagnosis, nor does it indicate these

specific shoes are required to treat her medical condition. The letter

does not also say that the specific shoes Ms. [redacted] purchased or orthopedic

shoes. We have two options at this point. The first option is for

Ms. [redacted] to have her physician resubmit the letter of medical necessity.

If she chooses this option, it may be helpful for her physician to complete and

sign the form we provided in our last correspondence. The letter we did

receive from her physician was missing key information, and our Letter of

Medical Necessity form would provide the outline for the specific information

we are looking for.

The second option is to have a third party independently review

the claim. This is an option listed in her Summary Plan

Description. Under the Patient Protection and Affordable Care Act

of 2010 (PPACA), there are standards set forth for plans and issuers regarding

both internal claims and appeals process and external review. PPACA implemented

consumer protection standards for an external review of adverse benefit

determinations based on medical necessity, appropriateness, health care

setting, level of care, or effectiveness of a covered benefit. The

external review process is conducted by an accredited Independent Review

Organization (IRO). We would submit all claims documentation to the IRO,

including the correspondence between Ms. [redacted] and Employee Benefits

Corporation. Ms. [redacted] would be allowed to submit additional information

in writing that the IRO will consider when conducting the external

review. The IRO’s decision is binding on Ms. [redacted] as well as Employee

Benefits Corporation. The IRO will provide written notice of its decision

to uphold or reverse the adverse benefit determination within no more than 45

days after the receipt of the request for external review. Please let us

know how Ms. [redacted] would like to proceed.

Consumer

Response:

Review: I am appalled with the lack of quality service provided by Employee Benefits Corporation/Cobra Secure. I am unsure of the name of this company as both names are prominently printed on the paperwork. I've emailed several times detailing my concerns just to receive a generic reply which proved the rep did not "really" give my message the appropriate attention. After contacting the company again via email the rep, again responding generically, suggested I did not call within normal business hours. Even after being insulted, I followed the generic instructions just to have the rep on the phone not be able to locate my account. This same company has also sent "corrected" paperwork. I am not surprised their apparent ineptitude judging form the obvious significant lack of quality customer service.Desired Settlement: I need to have this issue resolved appropriately. and immediately.

Business

Response:

Ms. [redacted]:

I find it outrageous that they want to charge individuals $20 every time if you make your COBRA payment online!

+1

Review: Our employer contracts with EBC to file claims for medical services we have received. We have requested reimbursement for additional expenses we have paid and for the outstanding bill that has not been paid by EBC. The explanation we received was this was due to a deadline date. The service date was on 12/14/15 and the date our insurance company filed a claim for this service to EBC was on 03/29/16, which is prior to EBC's 3/31/16 deadline for 2015 claims. Dr. xxx's office submitted the insurance information to our insurance provider, on 1/06/16. The insurance company submitted the claim to EBC on 03/29/16. On 04/26/16, we received a bill from Dr. xxx's office for the unpaid bill. A phone call was made to EBC to inquire about the unpaid bill. EBC explained that claims for 2015 are to be filed by 03/31/16. EBC processed the claim on 04/08/16. Our records document a claim was sent from the insurance company to EBC on 03/29/16. The explanation received by EBC is the claim was processed and denied by EBC on 4/8/16 due to "All claims and required documentation must be submitted no later than three months after the end of the plan year, the last day to submit claims for consideration is 3/31/16. "

I am very confused as it appears EBC had the claim as of 3/29/16 and then they processed it on 4/8/16. I do not understand why we are responsible if EBC processed the claim after the 3/31/16 deadline. If EBC received it on 3/29/16, then wouldn't this fall before their own deadline?

Furthermore, we have previously attempted to receive reimbursement for medical bills for medical services during 2015. After inquiring with our employer regarding our insurance benefits in December 2015, we were instructed to create an on-line account with EBC. After 3 months of trying to create an account, we finally called EBC during our next Holiday break (We do not get home from work until after 5 pm when the EBC office is closed). On 3/31/16, we contacted EBC to find out why were unable to create an account. It was discovered that EBC had mistakenly left out 1 letter in our email address. The error was quickly corrected, however, when I inquired about the process to be reimbursed if we have gone over the family deductible, EBC explained that forms would need to be submitted for this process. We promptly completed the paperwork and mailed it immediately. After a few weeks, we received a notice that reimbursement for the two claims were unable to be processed as they were submitted on 4/01/2016, with the deadline of 3/31/2016. When we called EBC on 3/31/16, regarding creating an on-line account to submit for reimbursement, this deadline, which was the on the day of the deadline, was never mentioned during this phone conversation.

I understand that there needs to be deadlines with submitting claims, however, if EBC received the paperwork by their deadline, then shouldn't they be responsible? Also, if EBC made an error in creating our account in order for us to submit claims, then shouldn't we be given an explanation that the deadline date was that actual date? It feels to me that EBC conveniently processed the claim from the 12/14/15 service date after their deadline and then denied reimbursement because it was after the deadline date. Furthermore, EBC withheld information about the 3/31/16 deadline when we inquired about the process when discovering EBC did not create our account correctly.Desired Settlement: Refund of payment for the 12/14/15 service date.

Business

Response:

We are in receipt of the inquiry from [redacted] regarding the claims payment out of her husband's EBC HRA plan. We appreciate the opportunity to provide further clarification on this matter. After reviewing the claims that were submitted and the date that they were submitted, we reached out to Mr. [redacted]'s employer to discuss the matter. Mr. [redacted]’s employer has updated their plan to extend the timeframe to submit claims and as a result, we have reprocessed those claims and the remaining 2015 account balance of $397.22 should pay out in the next week to ten days.I also reached out to Ms. [redacted] to discuss the situation and am working with her directly on some other questions that she has regarding her account. I apologize for the inconvenience we have caused Ms. [redacted] and believe that we have resolved this situation to her satisfaction. If you have any questions, please contact me at ###-###-####.Sincerely, [redacted]Executive Vice President of Operations

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. I am still working with EBC to resolve all matters regarding our account.

Regards,

Review: I have COBRA through Employee Benefits Corporation ([redacted]) because I am between the time I ended my last job and the time where my new company will cover my healthcare. [redacted] is supposed to work with [redacted] Plan on my coverage. Last month, I had to call them because [redacted] would not fill my prescription because [redacted] said I was not covered. It was supposedly corrected after I talked to a manager at [redacted] and [redacted]. They both apologized and said they would correct my records. [redacted] filled my prescription. Now I am dealing with the same issue this month. I went to fill my prescriptions. [redacted] called [redacted] and they said they had no record of me in their system. This is two months in a row and we have paid our COBRA payment for both months prior to the date it was due.Desired Settlement: I would like an explanation, apology, and written assurance that this will not happen in the future.

Business

Response:

February 27, 2014

+1

Review: I paid into Bestflex program when I worked and I have sent in several statements to try and get my money back that I paid in.Every week I called and sent in bills even from hospital,they had an excuse. They are sending me half of it after I got nasty and they finally checked them out. Now they are saying I can't summit any more and they are keeping the money I paid in. During the time I was paying it.the company wouldn't let me use it. That is my money I paid in and not theirs to keep. I work hard to make what I get. Please help me get my money that I paid in back.Desired Settlement: I just want what I paid in to be given to me.

Business

Response:

Dear Mr. [redacted],

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Description: Employee Benefit Plans, Insurance - Employee Benefits, All Other Insurance Related Activities (NAICS: 524298)

Address: 1350 Deming Way Ste 300, Middleton, Wisconsin, United States, 53562-4640

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