A. It is becoming more common for physicians to charge "hold the spot" fees (retainer fees, access fees) or require patients to pay for MD/VIP programs in order to gain access to care or preferred services from the physician (favorable appointment booking, shorter waiting times). Since FSAs cannot reimburse expenses paid in advance of services, "hold the spot" fees and MD/VIP fees are generally not eligible FSA expenses. These programs operate like insurance, and the applicable fees most closely resemble individual insurance premiums not eligible for reimbursement by a Health FSA.
IRS rules are clear that eligible expenses may only be reimbursed by an FSA plan after the expense has been incurred. Furthermore, to be reimbursable, a particular medical service or treatment must have a direct link to an actual charge. Where payment is made but no service is incurred, or where a service is incurred but there is no corresponding charge for the service, that payment or service may not be reimbursed by a Health FSA. The presumption is that these expenses are not eligible for reimbursement.