Anonymous wrote:How much would you be willing to pay? I could help …mostly because I do it for my family but don’t have the extent of bills you do.

However, you need a simple tracker for health, dental, vision, then logins for all portals (yes even kids), then create folders for each individual by institution, save the actual bills there throughout the year. The EOBs are mostly worthless you review them if the number is off or call billing or ask for a breakdown of charges to understand the number. Once you do the initial setup that takes the longest it’s just a matter of saving files. Also why are you getting reimbursements is this from HSA? And FSA? That’s fine but hopefully not overpaid bills reimbursements.

21:49 and I don't find EOBs worthless at all. They show what I owe, which is good enough for the FSA.

21:49 again. Also on the medical insurance the website itself may allow you to filter to a given doctor and then save as PDF for the whole year. I do have enter claims one provider at a time for the FSA, but you can group the same provider and do the date range thing.

Your husband's costs are more than 7.5% of AGI after Medicare and his insurance? Is part of it prescriptions?

Here's what I would do/have done to some extent depending on the year:

Do you have an FSA card or do you submit everything manually? Either way, prescriptions are any easy thing to get with the FSA. If you have Express Scripts, and I expect this is true with other Rx insurance, you can download have a report by person (or you may have to get kids to download their own due to age if you aren't set up with permission to see theirs) that shows the patient portion. If you haven't used the FSA card, you can submit the whole report and say it's claims from X date to Y date.

You can also do date ranges with therapy if you can figure out your portion. It's probably the same amount each time once you get past the deductible? You need to ask the therapist for a superbill. I'm assuming they are out of network. Say the therapist charges $150. What I would not do (can't tell if you are doing this or not) is pay the $150 on the FSA card at the appointment. Pay the $150 on a regular credit card. And you'll have the superbill showing you paid $150. Then the EOB may say their allowable charge is $100 and you owe 20% of that. So you owe 150-100 = 50 for the part that's more than they allow plus 20%*100=20 for the part they don't allow. So $70. Usually you can find that number on the EOB. There might be separate columns for each piece. You should be able to just submit the EOB to the FSA without even needing the super bill, but you do have to claim the correct amount of $70 in this example or they will say it doesn't match. Is this helping at all?

Our various insurances typically allow you to download the whole year of claims in a CSV file. Then you can sort and filter by person. And add the data from each insurer into the one big spreadsheet.

If you tell us the column headings you see, maybe we can tell you which ones mean what.

Anonymous wrote:

Anonymous wrote:Also why are you getting reimbursements is this from HSA? And FSA? That’s fine but hopefully not overpaid bills reimbursements.

It's an FSA through work. I'm actually questioning whether I should even contribute to one. Since our medical expenses are so high, we can deduct anything over 7.5% of our AGI anyhow. Keeping track of which expenses I paid through the FSA and which ones I didn't so I can count it towards the tax deduction report is maybe one task I could drop if I skip the FSA in the first place?

One thing to note about FSAs is the money is also exempt from FICA tax so that could save you some money there. However, if you are already above the social security maximum, the savings are going to be pretty low (medicare only). I could certainly see a world where it is not worth the hassle to keep track of what has been FSA reimbursed versus not.

Even if they don't send a bill you do know how much they charged your credit card. Take that and match up the numbers on the EOB. Circle them, scan paired with cc bill.
You have to have the records but you know you don't have to send them in unless audited. So they can be an orderly box full of papers. I numbered each and just made a table of cost and number organized by type of charge.

I started a Google Sheet to track FSA and out of network claims. As a starting point, I copy/pasted the info from the insurance company’s claims info download section- has stuff like patient, date of service, billed amount, insurance paid, patient pays. Then I added any sections I needed - date that I mailed my claim (for those out of network that don’t bill insurance for you), reimbursement received from insurance, FSA claim date submitted, FSA date reimbursement received, amount of reimbursement (to track the balances).

It’s annoying and took several iterations to get the info that I needed for my family, but now it works for me. Even if I get behind on updating the sheet, it’s easy to see where I left off last.

Personally I wouldn’t pay someone because I think the amount of info and private medical data that I would have to explain to someone would make it complicated.

Anonymous wrote:Our FSA limit was easy to fill with dentist and pharmacy copays so when we deducted medical expenses in a few years when we had expensive surgeries with out of network surgeons, I just ignored those.
All you save is some income tax on the margin. It your expenses are that big you could bag the FSA but then have even more receipts to log.
Even with an accountant or bookkeeper you still need to give them the receipts.
I am not sure you need to hassle the portals because you only need what you pay, presumably there is a bill or invoice they send you or give you. That's what you deduct.

What I am dealing with right now is that we do not get sent any invoices. For instance, my son has a therapist who bills me (charges my credit card on file) and then as a courtesy files with my insurance company. Insurance company sends me a small check for the part that they cover. Insurance EOB has all the numbers on it but they add extra numbers so it isn't immediately apparent (to my FSA) exactly what I paid out of pocket. Because insurance has their "allowable amount" and "part you are responsible for" (but since therapist is out of network, I'm responsible for more than just that if that makes any sense.

I don't actually see a bill from the therapist. There is an online portal but I just checked and there isn't any receipt there that I can print out. I think I have to call the therapist and get them to send me a year's worth of receipts...It's stuff like that.

But I can see that even trying to get this all organized for some online bookkeeper to help me out will be a lot of work; if I am going to go to all that effort I probably should just take a day off of work and sort it through myself. I'm sure I can do it, I just really really don't want to.

Our FSA limit was easy to fill with dentist and pharmacy copays so when we deducted medical expenses in a few years when we had expensive surgeries with out of network surgeons, I just ignored those.
All you save is some income tax on the margin. It your expenses are that big you could bag the FSA but then have even more receipts to log.
Even with an accountant or bookkeeper you still need to give them the receipts.
I am not sure you need to hassle the portals because you only need what you pay, presumably there is a bill or invoice they send you or give you. That's what you deduct.

Anonymous wrote:Also why are you getting reimbursements is this from HSA? And FSA? That’s fine but hopefully not overpaid bills reimbursements.

It's an FSA through work. I'm actually questioning whether I should even contribute to one. Since our medical expenses are so high, we can deduct anything over 7.5% of our AGI anyhow. Keeping track of which expenses I paid through the FSA and which ones I didn't so I can count it towards the tax deduction report is maybe one task I could drop if I skip the FSA in the first place?

I would think that a personal assistant - remote admin assistant could do this, or a bookkeeper. Do you use a tax accountant? If so, I would ask them to outline what they want for tax purposes, and that would be the template for what the assistant or bookkeeper needs to document, in addition to taking care of organizing your documents and making sure bills are paid (I assume?). You probably want a background check and an NDA, both of which you could find online. If you do this thru a remote admin assistant business, I would think they would handle the background check and NDA as a standard practice. You also need to determine how much you can pay and estimate hours. That may also help you figure out what level $$$ of person you want to hire. I’m a CPA and do freelance bookkeeping and accounting, but I’m guessing my rates would be too high. I do understand the need. I have a child with special needs (doing ok now). When we were in the thick of twice weekly therapies and lots of Dr appts, I would spend a couple of hours each week on these things and I’m sure I left money on the table. I don’t think you need a specialist, but it would be necessary for the person to understand general instance workings and EOBs. You may also want to give them HIPPA rights at each Dr office so they bc an call and clarify billing questions. Those are the things I can think of now. My husband uses a remote admin asst - if you want a personal reference, let me know and I’ll sort out an email contact.

Oh and for the adult kids you have to get on as an. Account representative but that’s a one time call (I do it for my dad and Medicare)

How much would you be willing to pay? I could help …mostly because I do it for my family but don’t have the extent of bills you do.

However, you need a simple tracker for health, dental, vision, then logins for all portals (yes even kids), then create folders for each individual by institution, save the actual bills there throughout the year. The EOBs are mostly worthless you review them if the number is off or call billing or ask for a breakdown of charges to understand the number. Once you do the initial setup that takes the longest it’s just a matter of saving files. Also why are you getting reimbursements is this from HSA? And FSA? That’s fine but hopefully not overpaid bills reimbursements.

I think some kind of bookkeeper or accountant is the way to go. Ideally someone with experience with medical expenses and insurance.

Any ideas?

What kind of person can help me organize my recordkeeping in this situation?

I have a family of 4 - one very disabled adult who has a lot of medical costs - so much so that his expenses alone exceed 7% of our AGI. So we can deduct ALL our medical expenses above that threshhold from our taxes.

My two adult children (under 26) and I are both covered under his health insurance from work. He has Medicare as primary and his insurance as secondary. Kids and I have a decent amount of medical and dental issues with various doctors and dentists and therapists - all have their own billing system online. For dental coverage, my husband's insurance covers some and then I have insurance that covers some.

I have an FSA set up as well. So I just have a lot of bills and reimbursements and checks and deposits to manage - money is coming in and out. I can NEVER understand the EOB I get sent- can't figure out exactly what my FSA should reimburse or what I can list as a tax deduction at the end of the year.

I don't think I need a tax accountant for this, but some kind of bookkeeping help? I need to create some kind of workflow or process to track all bills, reimbursements and payments from the different insurers and the FSA to track out-of-pocket expenses versus reimbursed expenses. I'm worried about having proof in the event of an audit.

(It doesn't help that the kids are both still on our insurance but over 18 so I need them to print out documents and bills from their patient portals!)

I am really disorganized but trying to do my best but it would be great if someone knowledgable about both medical bills and taxes could help me get on the right track. Any suggestions?