Receipts for medical stuff (HSA)?

I have a Health Savings Account (HSA) through work. It's actually a really good deal, you put in pre-tax dollars, and if you use the money to pay for medical expenses, you don't pay taxes on it. Plus, it rolls over from year to year.

That said, I am having a really stressful time trying to get receipts from doctors.

Has anyone else had this problem? I recently had minor surgery.

Bill #1: Pathologist. I paid it online, and the system said that they'd email me a receipt. Nothing came through. I called, explained that I needed a receipt for my HSA, and was told no problem, they'd mail it to me. Two weeks go by, nothing. I just called a second time this week.

Bill #1: Doctor. The doctor was fabulous, but billing is causing me so much stress. First, they asked me upfront to pay my entire deductible (well, the amount left on my deductible). No estimate of the total bill, no receipt, nothing, just... "Oh you have ~$800 left to meet your deductible. We really like to collect that before the procedure. How would you like to pay?"

I paid that. Had my surgery. A month later, got the bill... and saw absolutely no mention of the money I'd already paid! Called and left a message...

Got an email back a few days later with the adjusted amount, went online, paid... but no receipt! And, the website they use hates me, it doesn't work on my version of Firefox, and won't give me a receipt without creating an account. I could cry at this point.

I email back and ask for a receipt, and get a message that she's forwarding me one from the system. Great. I get it, but it literally says, "$800 paid". No mention of the extra money that I paid after that, no mention of the doctor or practice or what was included (all that's required to access your HSA!).

It's *insane* and really stressing me out. I don't understand why this is so hard?

Bill #3 - TBD. The anesthesiologist (thank you, spell check!). I've seen the bills go through my insurance, but haven't gotten anything yet. I'm sure it will also be a battle.

Any tips? Has anyone else had to fight their medical providers to get basic receipts that show the services performed, costs, and that payment was indeed made? This seems so ridiculous to me. This should be a no-brainer, I'm not asking for the moon here!

Thanks... I'd love to hear everyone's experiences. Maybe it's just me?

If they will accept checks, then you can use the cancelled checks in your bank statement as receipts maybe? I don't know how detailed the receipts need to be. Maybe if you call your insurance company and get them to crack the whip? IDK

Thanks x123! I appreciate the feedback.

As it turns out, the receipt needs to actually show the medical services, the amounts charged, and that it's been paid. It's for the IRS, so there's not much wiggle room.

But, I got an email from someone at the office, and they said no problem - they'll be printing and sending me a receipt. Fingers crossed that it goes smoothly!

Thanks... and thanks for letting me rant a bit. Things have been stressful here the last few weeks.

I have nothing helpful to share with you, but your post is interesting to me, in showing how this innovation in American healthcare financing hasn't been quite fully thought through. You sound so well-organized and meticulous that I'm convinced you are doing your part in jumping through the necessary hoops. It seems, then, that when this system was set up, no sufficient incentive was built in to motivate doctors to provide you with what you need to mobilize your funds in your HSA for your self-reimbursement. That's what I mean by "not quite fully thought through."

There's got to be a way that an effective incentive could be built in. Doctors can be depended upon to do what they need to do to get their money. Apparently, they don't really give a flip, if you get yours. There's got to be a way that they could be made to "care." You should never be asked to make any kind of payment to any doctor, without receiving an invoice and a receipt. That's messed up, but I believe it works as you say it does.

Hi Rose76,

I completely agree with you. It's crazy, isn't it? Nowhere else are you expected to prepay with no breakdown of the costs, and then not actually get a receipt. I am having trouble wrapping my head around it.

And, I still haven't gotten that receipt! I need to follow-up with them, but it's painful to keep nagging for it.

This was a fairly minor, in-office surgery. Here's how it's played out.

1. Before the surgery, the doctor's office told me that I had $770 left to meet my deductible, and that they preferred to collect that money before the surgery. No breakdown of costs, no receipt. Just a request for a large sum of money before we could proceed.

I double checked with my insurance company before paying b/c my plan doesn't have copays, and (for normal visits) usually requires the doctors to bill insurance before they bill me, but insurance said that this is happening more and more, and that they had no control. So, I paid.

2. Had the procedure. No talk of finances at all (other than the payment from #1, which I did right before going in to see the doctor).

3. Got a bill from the pathologist. Paid online, assuming I could request or generate a receipt that way. The system said that I would have a receipt emailed to me, but none came. Called to get a receipt. Had to call again 2 weeks later. I now have the receipt! Success.

4. Got the bill from the doctor's office. Confusion, because it didn't show the $770 that I had already paid as a line item (although the balance due reflected it). Called the doctor's office to check the amount (and had to leave a message, b/c nobody answers the phone there). Got an email verifying the correct amount, and paid online. No receipt, again.

Emailed back and forth. She told me to try the online system.. I couldn't figure out how to generate a receipt from it. She told me that she'd have it generate a receipt for me, but that was literally just one page that said, "you've paid $52" - no breakdown of what was paid, and no mention of the $770! Emailed again... and that's when she told me she'd send me the receipt, but was working from home (just before the holidays). So far, I have not received anything, and need to contact again.

3. On my insurance website, I can see that the anesthesiology team put through a bill, and that I'll owe more money. I haven't received a bill yet from them, which is causing me some stress. I don't think I have any contact info for them (I might, I need to go through my paperwork, but I'm not sure). I'm guessing there will be a whole other bunch of hoops to jump through to get the receipt for that.

Everything about this seems so unnecessarily difficult and complicated and screwed up to me. Same thing with some of the shenanigans that I've dealt with trying to get out-of-network insurance reimbursement for therapy, just craziness and having to re-submit every other claim.

It seems that the system is pretty dysfunctional to me... I really wish we could get some actual work done in *fixing* it. I'd volunteer to be on a panel (my day job is in user-experience, so I think I'd have some good insights ).

It just *pains* me.... and as I said, this was a fairly simple procedure. I shudder to think of what it's like trying to deal with a major health crisis that involves hospitalization.

Back to the receipts... aren't there actual laws on the books about credit card receipts (i.e. not showing the full number)? I'd love to see a law for medical receipts as well, as you said, that any time you make a payment to a medical provider, they're required to give you a proper invoice and receipt that can be used for tax purposes or HSA reimbursements. And if they don't, there should be a fine that gets paid back to the patient!

Thanks!

You know these doctors have been known to do funny things when coming up with charges. I agree with all your ideas. Like . . . why can't they manage to do what a car mechanic does? First, they give you a written estimate, get your written consent to the proposed work, do the job, then collect paynent. And auto repair can involve some very big ticket jobs.

I'll bet more is "negotiable" than you have any idea. Try just saying "No" next time. Tell them you've got to see something on paper, before you hand over any payment. Don't ever pay in cash. Make sure you have a paper trail being generated on your part - check that has been cleared, or credit card statement.

We've been using our HSA for years now and have never had to show a receipt to the IRS. In fact, while the first year I was really diligent about keeping receipts, I honestly don't keep them anymore. It just hasn't ever been asked for. No payments have ever been disputed (nor should they have been because everything was part of the allowed coverage). I honestly wouldn't over-stress about keeping up with a million receipts. Unless you think it might be a questionable charge, you should be fine. Our funds are available through a HSA debit card, so we just use the debit card to pay our medical bills and that's pretty much the end of it. I've never had to submit anything directly to the HSA account that way. Do you not have a debit card for your account?

guilloche, I think if I were you I would take comfort :-) that you are doing all this now, this January, for next year and eventually it will get sorted out AND the doctors will know you and what you want/need and quit being so sloppy for you

I just started with a new doctor/system and have procedures lined up for this month and next and am already messed up with my meds at CVS :-) and can't wait to see how the actual medical bills will cause headaches, LOL. I have a son helping me, you have any family or friends that can help/commiserate with you?

Lolagrace... be careful about not keeping receipts! It's true, you don't need them to take the money out. That's because, unlike an FSA, *you* are responsible for making sure that you're using the money for an "acceptable" purpose ("acceptable" by IRS standards).

But, if you ever get audited and don't have the receipts, the funds you take out will be taxed. Plus, if you're not yet retirement age (I'm not) there would be an additional penalty (something like 20%).

Here's a thread from the Bogleheads' forum, where most of the posters tend to be higher income and pretty savvy with managing money:
https://www.bogleheads.org/forum/viewtopic.php?t=156240

Just glancing through the first page, a couple people confirmed that they had recently been audited and indeed, they needed to show that the money they took out of their HSAs was for allowable medical expenses.

You can also see here... https://www.irs.gov/pub/irs-pdf/p969.pdf - this is the PDF from the IRS website about HSAs. On page 9, they say:

I'm not trying to go nuts on you, but... yikes! I'd just hate to end up in a situation where I knew that I spent the money legally, but couldn't prove it, and ended up getting stuck with fines/penalties/taxes (plus the headache of the audit).

Plus, I assume if you get audited and something like this comes up, they'll suddenly decide to audit a bunch of your other returns...

The tax advantage is really amazing. I was doing some calculations... since my state has an income tax, and since my HSA is funded directly from my paycheck (so I don't pay FICA taxes on HSA funds either... which I would if I funded it myself) - my tax rate ends up being close to 40% total.

That means that for a medical bill that is $1000, if the IRS determined that it wasn't a qualified withdrawal, I'd be stuck paying an extra almost $400. And that doesn't include the 20% penalty (another $200). Yikes.

The receipts are definitely a pain. And, if I used an FSA instead, I wouldn't need them at all (the FSA company takes on all the risk - you submit receipts to them, and they approve them or not). But, you can't roll that money over year to year or invest it. With the HSA, I'm able to keep my receipts for now without taking out the money, keep saving, invest the money (the earnings are also tax free if used for medical expenses), and reimburse myself down the road when I need money. It's amazing, really, when you look at what you get with it.

Anyway, hope that wasn't too tedious or too much of a lecture.

Rose: You're so right. I get nervous about those bills too (though I finally got the anesthesiology bill, and it's awesome! Everything is spelled out, I can see exactly what drugs they used on me!) It's hard when you don't speak "medicalese" to even double check things for accuracy.

With this, I felt OK pre-paying. I had seen the charges from the first visit go through my insurance company, but they had not yet billed me. So, of the $770 they were asking for, I knew ~$500 would go to pay what I owed from that first visit. And, I knew the surgery would be more than that.

It's still a pain. I'd love if they did estimates. I'm fine with not requiring them for emergencies (when someone comes in with a heart attack, you don't need to stop and discuss finances, just fix them up!). But in this case, with several weeks between my first appointment and the surgery, an estimate would have been amazing and would have really made me think the world of the doctor's office. As it is, I love the doctor, but am really not sure I want to deal with the office... it's so hard to reach anyone over there!

Perna - LOL thanks, that's a good point. I don't know if/when I'll be back for this doctor though. She's a specialist, and hopefully I don't have any more problems for a long time with this particular body part I really *hope* I don't have to go back, anyway!!!

Thanks... I've been sick (had a cold), so haven't dealt with this... just emailed the doctor's office back today to ask about the receipt again. I mailed my payment to the anesthesiologist, and included a note asking for a receipt.

I have an FSA not an HSA (sorry about that - realized you were talking about the other type of account - we don't have that one available), and yes, the company that manages the account takes care of the paperwork. We never have any money left in the account to roll over because we have huge medical bills due to my husband's medical condition (I would love to have that problem). I don't claim additional medical expenses on my tax return (wouldn't be enough left to claim).

We have only used our account for meds and direct doctor/hospital bills which are easily verifiable and probably why in all of these years none of our claims has ever been audited/disputed. I really don't worry much about it.

Ah, phew... thanks for clarifying Lolagrace, that makes sense. With the FSA, you don't have to worry at all... even if you get audited, you're not responsible for making sure that your FSA-expenses are "legal" per the IRS. The administrator has to take care of that. So, you're good!

Ugh. I just need a place to vent my frustration.

Still no receipt from the doctor's office. I don't understand, this should not be a difficult task.

I've sent a follow up email (replying to the email that I received before Christmas, where someone in billing says that she's working from home, but will send me the receipt when she's back in the office). Very politely letting them know that I hadn't seen anything yet (via email or snail mail), and wondering if they could help me get a receipt.

Then, this Monday, I called and left a voicemail (b/c it's impossible to get a human on the line). Still no reply.

They may have tried to call, but I screen my calls at home (I have a father that has bad debts, a current foreclosure situation, and is trying to declare bankruptcy - debt collectors seem to want to call ME about this, plus a brother who struggles with drug addiction. And I work from home. Yes, I screen my calls.) They haven't left any messages, and if they would... I'd of course pick up. No emails either.

This feels insane to me. To the point that, even though I really *loved* the doctor and thought she was wonderful, I don't want to go back. It's a stupid receipt... how hard can it be? Both of the other parties involved were able to generate and mail me a receipt. Again, this should not be so hard.

Thanks for letting me vent a bit. My sister is telling me I should drive down there, but it's downtown (I'm in the suburbs), at a hospital, and you have to pay to park. I'm not sure that showing up is going to help me, though I'm starting to think I might need to do that.