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PayFlex Systems USA, Inc, Keller, Texas Complaints & Reviews - Refusal to pay after submitting appropreciate docs

PayFlex Systems USA, Inc Contacts & Informations

PayFlex Systems USA, Inc

Posted:    Pam Schlutt

Refusal to pay after submitting appropreciate docs

Complaint Rating:  90 % with 21 votes
Contact information:
PayFlex Systems USA, Inc
Keller, Texas
United States
I have a complaint that I want to submit to the government agency that manages the Flex insurance carriers, but do not know who to contact.

My complaint is with PayFlex Systems USA, Inc. I have submitted a stack of receipts and co-pay charges from my doctors office, with legitimate letter head, and PayFlex has refused to pay. Now I can understand refusing to pay from the charge receipts, since they can be from anywhere, but the receipts I sent listed date of service, what service was for, my co-pay charge, and the amount billed to insurance. That is a legitimate receipt; at least, it has been the accepted form of receipt from Flex insurance companies in the last 10 years. Has a law changed? Has anyone else noticed that it has become harder and harder to get the money you contribute to Flex to get it out?

An inquiring mind would like to know.
Pam Schlutt
Comments United States Health & Life Insurance
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 17th of Aug, 2010 by   vickivb +1 Votes
I completely agree with you. I have done the same thing, when I inquired as to when they would re-activate my card, I was told "due to them auditing my account, they now need documents from 07/2008". This is now mid-August 2010. I bet they wouldn't have told me except I called.
 17th of Aug, 2010 by   vickivb +1 Votes
I don't think I'll have Payflex again!
 18th of Nov, 2010 by   gc86 +1 Votes
Do not use Payflex. I faxed them receipts, and spent hours and hours on a legitimate $129 charge. My Payflex deduction next year is ZERO.
 21st of Jan, 2011 by   Ronald Bertswarth -1 Votes
Pam Schlutt, Vicki, and gc86... I find it difficult to believe that you would hold a third party administrator such as PayFlex in contempt for regulations set forth by the IRS. Pam, if your itemized statement only showed the amount billed to insurance then this is an ineligible expense. The IRS requires that all claims be substantiated with final patient liability, and an amount billed to insurance without showing an actual insurance payment is NOT final liability but rather is estimated liability. When you use your card or file a claim, you agree that you will not seek reimbursement elsewhere, but when your documentation shows that insurance has been billed, then it is PayFlex's responsibility under IRS guidelines to wait until insurance actually pays before paying your claim.

You people can be upset all you want at PayFlex, but just keep in mind that 95% of FSA administrators are not IRS compliant; PayFlex is among the top 5% compliant, so your complaints are with the IRS and not with PayFlex.
 21st of Jan, 2011 by   Ronald Bertswarth -1 Votes
Oh and by the way, it is your employer who would be held liable if PayFlex is audited and found to have reimbursed you for ineligible expenses. So you can be mad all you want, but really it's not fair to your employer to be fined, nor is it fair to PayFlex to reimburse your ineligible claims and suffer the wrath of your employer and potentially lose business because of it.
 21st of Jan, 2011 by   Ronald Bertswarth -1 Votes
Last but not least, Vicki, you can go onto www.mypayflex.com and click Documents on the left-hand side, and you will probably find multiple request letters for those 2007-2008 card charges, with the date and time they were mailed to you. Now who's fault is it that you didn't respond for 2-3 years??? You're mad at PayFlex over this? Unbelievable.
 18th of Feb, 2011 by   A Fritz 0 Votes
We have been getting the same runaround with PayFlex. They recently demanded d0cumentation for legitimate medical expenses we incurred and that PayFlex paid several years ago. They refused to disburse money for recent medical expenses until they received the documentation. It is entirtely possible that PayFlex is making illegal profits by placing unwarranted holds on accounts, since any unused funds in the account are forfeited to the company at the end of the period. This looks to me like a potential class action lawsuit.
 18th of Mar, 2011 by   Claudia Binder +1 Votes
Pay Flex is claiming that I owe them >$.600. They take $50 out of every paycheck of MY money & are refusing to pay legitimate expenses. I can't seem to get out of the system. Count me in if you file a class action. cbinder@austin.rr.com
 9th of Apr, 2011 by   shane in ok +2 Votes
My business just switched to payflex this year, and i have never had a problem with a flex plan until now. they deactivated my card and refuse to pay for a freaking dental visit. I'm so mad right now with that sorry company I can't see straight.
 27th of Jul, 2011 by   Niki222 +1 Votes
I agree with all of you I have never had more trouble with FSA until Payflex I do realize laws have changed that makes using your FSA not valid with many of the purchases we used to get, but still it is ridiculous...I am going to treat myself to really expensive pair eyeglasse frames... to take care of the remaining balance.

HA HA take that ... Pay flex
 30th of Sep, 2011 by   Misha2 +1 Votes
I am so very disgusted with Pay Flex!!! I have spent endless hours trying to get payment and there is always an excuse. Now, they claim to have no documentation. I thought Wage Works was horrible. They are much worse. I really think they are perpetrating fraud.
 19th of Oct, 2011 by   sierrani -1 Votes
Everyone on here complaining needs to re-read exactaly what Ronald Bertswarth posted before you blow up and realize it's you being a fool and not submitting the correct documentation. Here are some key things to remember: 1. If the bill does not show a service, date of service, billed amount and provider - you will not get reimbursed. 2. If you bill shows estimates or billed to insurance - you will not get reimbursed. As for your card getting shut off for failing to send the proper documentation when you were notified multiple times 1. Per IRS guidelines the card will get deactivated until proper documentation is received. 2. You have noone to blame but yourself for failing to do anything about it when you received the notices and/or followed up to see if you submitted the correct information.

Also, saying your going to "empty out your account", as if to cause harm to your FSA administrator not only sounds very childish, but is indeed not doing any harm to the FSA administrator at all since they technically do not "hold" your funds, your employer does. You may think your FSA administrator is out to keep your money, but the sad reality is that they are actually there helping you, if you were to be reimbursed for the things you are whining about, you would be whining more when you get nailed with a hefty IRS penalty when audited for claiming expenses that you can not validate.
 19th of Oct, 2011 by   DavisFAMILY +1 Votes
We have had the samolde problem with Payflex. We have turned in document after document, only for them to request more. Not only that, but we paid close to $1000 into it this year to cover midwife expenses, only to be told we have to pay for these services before we are reembersed. So, now we paid the midwife and subefitsmitted the receipt only to be told we need yet another document "Explination of Bennefits" that basically says that our primary insurance doesn't provide midwife services. The only insurance I'm receiving is that this Flex-Plan business is a SCSM. The reason I got this insurance is to make sure that we were covered during the pregnancy that our primary insurance didn't cover. So far, we haven't been reembersed anything. Not even what was paid into it. Everyone has seemed to have been paid but us. Not quite the outcome we were expecting. This experience has been a waist of time and resources.
 29th of Nov, 2011 by   hparsons +1 Votes
Sierrani and Ronald Bertswarth - your information may be correct, but your generalization that those of us complaining are "being a fool", "not submitting the correct documentation", and that our "complaints are with the IRS and not PayFlex" are incorrect (as generalizations typically are). I received two documents asking for an itemized receipt for orthotic inserts for which I paid with my PayFlex card. The reason for denial was "Personal use - Need cost difference", which was simply not the case. We faxed in the detailed receipt as requested, but I still felt uneasy that they were threatening to deactivate my card, so I called them. After getting some incorrect information from the first person I spoke with (she told me to purchase another insert over the counter, submit that, and I would be approved for the difference), I finally got someone who I thought was giving me correct information. The supervisor I spoke with stated that the original claim was probably denied because someone thought it was shoes instead of inserts (because of the price). She instructed me to write on the receipt that it was for inserts, and reassured me several times, that this would take care of the problem and my card would not be deactivated. I did so (they admit they have the document) and a month later I got a deactivation notice. A call this time finally got the information that I must provide a letter of medical necessity. My complaint with PayFlex is not that I must submit that letter, but that they never told me that. Three letters from PayFlex, none of them mentioned the letter of medical necessity. Neither of the two people I initially spoke with on the phone (rep and supervisor) mentioned a letter of medical necessity, doing EXACTLY as the supervisor told me still resulted in my card being deactivated (with no additional notice). PayFlex's documentation claims that I "failed to respond" to their repeated letters, which is patently false. They even have the response, and acknowledge that they do.

I DO agree that simply emptying out my account is futile; however, detailing the information to my HR department and registering a complaint about the poor service is not. I recommend anyone having similar problems with PayFlex make sure their employer's HR department is aware of the problems. That's the ultimate customer to PayFlex, and that's the only way to get their attention.
 7th of Mar, 2012 by   jtmuz +1 Votes
My experience has been absolutely HORRIBLE with PayFlex.
 7th of May, 2012 by   Randal B Goodrich +1 Votes
I want to like Payflex, I really do, but here's my family's verdict (drum roll...): in our objective opinion they deserve a D- for broken internal processes at this "service" which assessment goes beyond the huge hassles & significant delays experienced us and by many on this blog. Surely scores of others have not yet voiced their opinions here, with BBB, etc., but maybe they will come forward It seems only a matter of time before the mushrooming systemic problems at Payflex become more widely exposed.

There might be talk of class action lawsuits - seen it posted here and elsewhere a few times, but I hope it doesn't come down to that. The majority of us want the same things: we want reasonable service with minimal headaches when seeking healthcare. We deserve access to our Payflex cards and to our own money. I don't buy the line that we can still use our account with a frozen card; it is not the same as before. At one time that system worked, and I'd cut up my card now if I had faith in the current fax-to-Payflex process today. The plastic debit card concept sounded wonderful when introduced but has proven worthless to us.

I am too weary to say much more about Payflex at this time - wish I could lay it all out now. I have plenty of both anecdotal and factual background to share, but your time and mine time is too precious. I will soon be leaving for the airport to catch a cross-country flight, but I will offer this much now, perhaps more another time:

Just today, I was disconnected by Payflex after listening to elevator music for 15 minutes, misdirected several times before that. With no ax to grind, just seeking a simple explanation with a mature witness nearby, I followed every prompt and direction given, made every painstaking move by this company only to hit a brick wall. The system has become mired with problems, dead-end fax transmissions (despite verified fax records showing otherwise) peanut butter-slow responses to faxed in receipts, etc. etc.

In the past two years I've been stymied repeatedly after following every step they provided. Part of the problem might be the inconsistencies between the hired staff, which even Payflex managers have acknowledged, "Well she was wrong sir, you were misinformed!"

Today, my wife and I opened the Payflex letter with great anticipation, pausing to review all the steps followed for validating an ambulance ride and routine dentist procedures, but wouldn't you know it, there was an "overpayment" of $2 so our card is still inactive. This is our absolute last gasp of hope with Payflex. This year we decided to give them one last chance, so we contribute a little money from each paycheck. Last year we lost $1500 - unable to use it in a short amount of time due to entanglements and misunderstandings and poor communications on their end (trust me, I have it all captured in a dozen e-mails to our benefits administrator).

Then we learn that Payflex went back to 2007 looking for problems with our account - we'd never heard of any issues prior to that time (someone here suggests that this an audit, but another rightfully asks why we have to find out after making inquiries as to our status). We ended up writing checks to settle a hospital visit that we still have an issue over paying twice - it was their word against ours - and despite assurances that things would improve so that customers could settle immediately - we still could not pay via credit card over the phone.

It's the waiting game that hurts us, jump through hoops to find a new problem has surfaced.

I believe that they were better at their own business at one time, more customer-oriented, more organized, etc. One day if neutral parties will carefully evaluate how business is conducted - and not just wait for complaints to be filed - the truth will come out.

I realize that the IRS has imposed recent rules on purchasing and reporting, but please forget the IRS and even the occasional "block headed" consumer for a moment. We know that there are always that certain customer that doesn't follow the rules, doesn't send in all the correct documents. I had to play the game for nearly a decade, quickly learning which receipts were legible and acceptable, slowly training my local health care providers to give me the proper receipts carefully printed by them (largest hospital chain in my state) and then faxed and followed up by me. But something has changed = not just by the IRS - but by Payflex themselves. You can have multiple college degrees or be a graduate from Life's School of Hard Knocks and still get Line-Item vetoes at every turn over technicalities ("What do you mean you needed an ambulance?!" and then what happened today.

It's appalling and disappointing. I wish I could have spent this past half-hour stating more positive things about Payflex. I wish you a better outcome than has been our experience with this outfit. Ugh! Gotta fly now. Good luck to all.
 7th of May, 2012 by   Randal B Goodrich 0 Votes
Bummer, apostraphes posted looking like cuss word (symbols), so I will send shorter version now with contraction-words spelled out clearly (too much time spent to toss previous efforts out). Thanks to all comments both Pro and Con. Happy reading and hopefully happier flex-spending to all:

I want to like Payflex, I really do, but here is my family's verdict (drum roll...): in our objective opinion they deserve a D- for broken internal processes at this "service" which assessment goes beyond the huge hassles & significant delays experienced us and by many on this blog.

The majority of us want the same things: we want reasonable service with minimal headaches when seeking health-care. We deserve access to our Payflex cards and to our own money. I do not buy the line that we can still use our account with a frozen card; it is not the same as before. At one time that system worked, and I would cut up my card now if I had faith in the current fax-to-Payflex process today. The plastic debit card concept sounded wonderful when introduced but has proven worthless to us.

Just today, I was disconnected by Payflex after listening to elevator music for 15 minutes, misdirected several times before that. With no ax to grind, just seeking a simple explanation with a mature witness nearby, I followed every prompt and direction given, made every painstaking move by this company only to hit a brick wall. The system has become mired with problems, dead-end fax transmissions (despite verified fax records showing otherwise) peanut butter-slow responses to faxed in receipts, etc. etc.

In the past two years I've been stymied repeatedly after following every step they provided. Part of the problem might be the inconsistencies between the hired staff, which even Payflex managers have acknowledged, "Well she was wrong sir, you were misinformed!"

Today, my wife and I opened the Payflex letter with great anticipation, pausing to review all the steps followed for validating an ambulance ride and routine dentist procedures, but wouldn't you know it, there was an "overpayment" of $2 so our card is still inactive. This is our absolute last gasp of hope with Payflex. This year we decided to give them one last chance, so we contribute a little money from each paycheck. Last year we lost $1500 - unable to use it in a short amount of time due to entanglements and misunderstandings and poor communications on their end (trust me, I have it all captured in a dozen e-mails to our benefits administrator).

Then we learn that Payflex went back to 2007 looking for problems with our account - we' had never heard of any issues prior to that time (someone here suggests that this an audit, but another rightfully asks why we have to find out after making inquiries as to our status). We ended up writing checks to settle a hospital visit that we still have an issue over paying twice - it was their word against ours - and despite assurances that things would improve so that customers could settle immediately - we still could not pay via credit card over the phone.

It is the waiting game that hurts us, jump through hoops to find a new problem has surfaced.

I believe that they were better at their own business at one time, more customer-oriented, more organized, etc. One day if neutral parties will carefully evaluate how business is conducted - and not just wait for complaints to be filed - the truth will come out.

I realize that the IRS has imposed recent rules on purchasing and reporting, but please forget the IRS and even the occasional "block headed" consumer for a moment. We know that there are always that certain customer that doesn't follow the rules, does not send in all the correct documents. I had to play the game for nearly a decade, quickly learning which receipts were legible and acceptable, slowly training my local health care providers to give me the proper receipts carefully printed by them (largest hospital chain in my state) and then faxed and followed up by me. But something has changed - not just by the IRS - but by Payflex themselves. You can have multiple college degrees or be a graduate from the School of Hard Knocks and still get Line-Item vetoes at every turn over technicalities ("What do you mean you needed an ambulance?!") and then what happened today.

It is both appalling and disappointing. I wish I could spend a half hour stating more positive things about Payflex. I wish you a better outcome than has been our experience with this outfit. Ugh! Gotta fly now. Good luck!
 21st of May, 2012 by   LB18 +1 Votes
Whoever mentioned that they were going to buy expensive glasses...BE CAREFUL! I did that, as I needed prescription glasses. I sent in the receipt, the doctors list of services, and it still got rejected. Also, I used their website to ID the missing documentation i needed to provide. I got emails from them saying my receipts were received and all cleared for each. Thought this was good, but no such luck. I called and was told that I didn't get emails, they mailed a letter denying those claims. I saved the emails, but got letters a few days later. I am still locked out and can't use my debit card. But I did get a convenient pay coupon asking me to send in $683...hey, wait. Isn't it MY money? And it was all over, for the most part, prescription glasses. Suggestions?
 18th of Jun, 2012 by   Seola1 +1 Votes
Pure junk. First, to the self-righteous Sierrani and Ronald Bertswarth, perhaps you should read the initial complaint. Especially Ronald - considering you said "they won't pay for yadda yadda" and you need "blah blah" and that's *exactly* what the original complaint stated they had. Second, don't trust the BBB at ALL. Once you pay the price to be "accredited", you get an A rating. Companies with F ratings have instantly turned to A/A+ overnight once buying accreditation. One company, even after multiple lawsuits they lost and dozens of unresolved complaints is still listed as an A+ company.

Now as for me, this place is AWFUL. Though one above is invalid (the new rules do not allow FSA to pay for ANYTHING unless you have a written prescription, and yes, you can get those now for inserts, walkers, etc.), the rest of these are valid. My card is now inactive. In 6 months, we've had 14 "reviews" we needed to submit documentation for. One included a co-payment directly to a hospital and processed as surgical copay and listed as such on the website. This isn't some rinky dink hospital but the major hospital in Southwest Florida and in the charge it actually states surgery. Do they think they serve hamburgers there? My EoB states the copay paid, because I had to pre-pay my co-pay to have my hysterectomy. The detailed billing states I owe nothing, and shows I prepaid $100 but doesn't specify how. I'm now waiting on a special letter from the hospital to submit together with the EoB, the bill and my insurance documents showing the requirement of prepay co-pays. I doubt it will work.

They denied payments to my son's psychiatrist because they didn't have "detailed" billing which is prevented by HIPPA laws. The "detail" states medication check and observation. They want a diagnosis on the bill or EoB, the treatment (there ISN'T "treatment" with the psych), and so on. It's against the law to put all that info inside a bill for mental health. Again, hoping that a special letter will fix this but doubtful.

They've also denied copayments billed from my four kids pediatrician. It's listed specifically, it's a standalone office and nothing there would or could be billed as anything but allowable expenses. I have the detailed EoB for the copayments... nope, denied. Not detailed enough because there's too much shorthand and they "can't be sure it's a medical visit" even though the itemized has a margin under each office visit. One even told me to submit the detailed bill with the vaccine names listed out (because obviously DTaP could totally be a ticket to Europe).

Even today, when trying to ask several yes or no questions since my card is locked, yet again - about the appeals process on one of my claims (partial denial, question was whether I needed to send all 3 itemized bills that were paid at one office visit or just send the one that was apparently missing from their evaluation though it was listed in the documents, they claim they never got it) - she said I can't appeal. I asked "I can't appeal the partial denial" and she started yelling at me telling me to listen to her after her 5th time around the script in which answered none of my questions. I didn't even get the first question asked before she interrupted me and continued interrupting me before I finally said "Just a yes or no is all I need" and began to ask it again and she started yelling at me for not letting her talk! Got to a supervisor who seemed annoyed I interrupted his coffee break and though he gave me the answers I need, he was curt and annoyed. But at least he answered.

So now, I get to pay out of pocket for all my post-op appointments, and wait to be unlocked. So that I can now go through the even more PITA process of trying to get reimbursed.
 18th of Jun, 2012 by   Seola1 0 Votes
Interestingly, Ronald is across multiple sites, somewhat condescendingly going after complaints. Of course, one could suppose he just "happens" upon negative reviews, but considering you have to search complaints to get to, well complaints - I think you've been outed. A search of your name reveals oodles of condescension. We get it, you're part of marketing.

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