FSAs, HSAs, and HRAs

As part of an employee benefit package, an employer might offer one or a combination of the following healthcare options:

A Healthcare Flexible Spending Account (FSA) is an employer-sponsored account that allows you to put aside a portion of your paycheck each month (pre-tax) to cover medical expenses. Note that Healthcare FSAs do not travel with you from employer to employer, and they reset each year; if you don’t use your funds before December 31st or before you change jobs, you will lose those funds.

Like an FSA, a Health Savings Account (HSA) is also an employer-sponsored, pre-tax account for covering health expenses, which you can pay into each month directly from your paycheck. Although HSAs are administered by your employers, you own the account: the funds you place in your HSA are accessible to you year over year, even if you change jobs or health plans.

A Health Reimbursement Arrangement (HRA) is an employer-funded health plan that will reimburse you for qualified medical expenses. HRA funds can roll over from year to year, so you may not lose them if you don’t spend them by December 31st. However, because HRAs are owned as well as operated by employers, the funds in your HRA won’t go with you if you leave your role and join another company.

How do I use my FSA, HSA, or HRA to pay for visits?

There are 3 ways that you can use your benefits to pay for visits:

• Pay with your FSA, HSA, or HRA debit card
• Apply for reimbursement from your FSA, HSA, or HRA plan, or
• Allow your health plan to coordinate in-network benefits internally(Note that this last option has several requirements to be applicable!)

If your benefit plan exclusively issues physical checks, you can still pay your invoices with a personal credit or debit card and then submit directly to your FSA, HSA, or HRA plan for reimbursement. See “Reimbursement” below for more details.

Option 1: Debit Cards

We accepts FSA, HSA, or HRA debit cards. 

Splitting Payments

Currently, our payment system is not set up to support splitting payments for patient invoices. We cannot apply partial balances from FSA, HSA, or HRA funds or debit cards to outstanding invoices.

Option 2: Reimbursement

In most cases, we are not able to work directly with your FSA, HSA, or HRA for invoice payment. This is because:

We have a limited view into FSAs, HSAs, or HRAs and the current funding status of these accounts that may pay for your claims.

We cannot coordinate directly with payers who are not active insurance partners with KEGE. (Common examples of plans we are not partnered with include BCBS, Beacon Health and ConnectYourCare.) However, you can still use your FSA, HSA, or HRA benefits for visits by submitting for reimbursement. 

Receipts for Reimbursement

To ensure smooth coordination of services, we strongly recommend that you pay your invoices up front with a personal credit or debit card. (Note that we do not accept personal checks.) 

Once you have paid your invoices, you will receive an email receipt that includes everything you need to file for reimbursement for your payment responsibility from your FSA, HSA, or HRA. If there is any additional information your plan requires, you can send us a note at support@kegecenter.com with the request. 

For specific information on how to submit your receipts to your plan, reach out to your FSA, HSA, or HRA fund directly. Your employer’s HR administrator or benefits manager should have contact information for your plan on file.

Explanation of Benefits (EOBs) and Reimbursement

Note that some FSA, HSA, and HRA funds require an EOB (Explanation of Benefits) from your primary health plan before they will reimburse your invoices.

You will receive your EOB directly from your insurance company once they have completed processing the claim for your session(s). You can find your insurance company’s contact information on the back of your insurance card, or you can reach out to your employer’s HR administrator for details. 

Generally, it can take up to 45-60 days from when your provider submits a claim until an EOB is available. 

Option 3: Coordination Among Benefits Within Your Health Plan

This payment option is only available under very specific circumstances. If your FSA, HSA, or HRA plan is managed by an insurance company that is:

• Partnered with KEGE, and
• Also overseeing your primary health plan (e.g., if you have an HSA and a primary insurance policy both managed by United Healthcare),

then we may be able to work directly with your health plan to get reimbursed for part or all of your payment responsibility. This would mean that you do not need to submit any additional payment or documentation to receive your benefits.

If you have a health plan that is in-network with KEGE AND an FSA, HSA, or HRA run by the same insurance company, then you would not need to submit receipts or otherwise create your own request for reimbursement.

Instead, when we submit your provider’s claim to your insurance, your insurance company will process all of your benefits internally, notify us of the applicable FSA, HSA, or HRA benefit, and submit payment to us on your behalf.

Example

Let’s take the example of Jane Doe, a client who has an HSA and a health plan both run by United Healthcare (UHC) to illustrate how this combination of benefits works.

• Jane works with a mental health provider who is in-network with UHC. 
• Based on Jane’s benefits, Jane’s payment responsibility is a $25 copay
• Following a visit with Jane, their provider submits an insurance claim for their services
• The biller directs the provider’s insurance claim to UHC (as Jane’s primary health plan) and invoices Jane for the $25 copay. 
• UHC processes the provider’s insurance claim. Since UHC manages both Jane’s primary health plan and Jane’s HSA, UHC coordinates internally:
  • They process the insurance claim
  • They pay the $25 copay from Jane’s HSA directly
• We receive the processed claim from UHC, and Jane’s HSA payment 
• We adjusts Jane’s copay invoice accordingly, either by canceling the outstanding invoice or refunding the copay amount if Jane has already completed payment

Key Takeaways

Timeline

In the case that your insurance company manages both your primary health plan and your FSA, HSA, or HRA benefits, this coordination can have an impact on the timeline of payment for invoices. 

We allow 60 days from the initial date of service for payment of patient invoices. Invoices will only be paid once the insurance claim has processed and been returned to us, which may take up to 60 days from the date the claim is filed and, in some cases, longer. 

Overdue payment of patient invoices can impact your provider, so it is important that you discuss this timeline with them before moving forward. 

Patient Invoicing

In this example, Jane received an invoice even though UHC wound up covering the whole cost of the visit. Why? 

When we run an eligibility check on a patient’s insurance, we will notify the patient of their payment responsibility. This payment responsibility is also the amount that we invoice patients after the visit occurs. 

Additional employer benefits, such as FSAs, HSAs, and HRAs, are often highly customized and individualized. We do not have visibility into these plans before we submit claims, even if we are partnered with the network payer that manages them. 

This is why you, as a patient, may receive an invoice upfront even if, ultimately, your payment responsibility may be covered by your in-network FSA, HSA, and HRA. 

In this scenario, you’ve got 2 options for managing these invoices:

• You can pay the invoice directly with a personal credit or debit card and then wait for reimbursement from us once the claim processes and your insurance company applies your FSA, HSA, or HRA funds.
• You can wait to pay the invoices until your insurance company completes processing the claim and returns their Explanation of Benefits (EOB) with your FSA, HSA, or HRA funds. While your claim is processing, you will continue to receive weekly invoice reminders via email, which you can disregard.

However, note that Option 2 can affect the timeline of payment, which may have an impact on your provider. (See “Timeline” above.)

For both of these reasons, it is essential that you discuss these invoice payment options with your provider. You can confirm the best option for both of you before moving forward.