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PayFlex Systems USA

PayFlex Systems USA review: Refusal to pay after submitting appropreciate docs 75

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1:38 pm EDT
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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

Resolved

The complaint has been investigated and resolved to the customer’s satisfaction.

75 comments
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Amberley
Batesville, US
Apr 17, 2013 4:23 pm EDT
Verified customer This comment was posted by a verified customer. Learn more

Here is the thing my son goes to the orthodontist monthly, only reason we decided to get pay flex. Our dental insurance paid $1500 and we paid $2700 cash. We owe $1800 and took pay flex to cover that expense. Our contract was signed in 2012 and faxed to pay flex prior to obtaining pay flex, more so for my benefit before obtaining. Needless too say I was told by Karmin G. (Will not post emoyee ID) and Sandy R (a supervisor) on 10/2012 that pay flex would cover the remainder of the orthodontist. However, after receiving the request for further information and faxing my child's information on detailed receipts 8 times my card has been deactivated because they say they have not received the documentation. When I ask to speak with someone in the "fax" department they do not have an extension. This not only violates HIPPA laws it's also unethical practices. I'm sorry but I read all documentation and consulted numerous times before getting pay flex and those of you that are defending pay flex obviously work or get contributions of other people's money, because this is unconstitutional, unethical, and illegal. Call their number and the automated systems states that it takes them up to 48 hours to process a fax yet when you speak to an agent it turns into 7-10 business days, then after waiting the 10 days you get " we didn't receive it". This is the most fraudulent company I have ever had to do business with. I am and will be perusing this legally. If interested contact abgreen2131@gmail.com

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jodaw
, US
Mar 15, 2013 11:13 am EDT

We've been jerked around endlessly by Payflex. It has become increasingly difficult to get any reimbursement from them. The past few years, each and EVERY time we submitted claims by fax, they DENIED receiving our documents. We had verification on our end that the fax was, in fact, received each time. We are currently fighting them over denying a claim we electronically filed for 2012. We filed our claim before the deadline, but, Payflex is saying they never received my documentation that I uploaded and submitted. As far as I know, there is no way to confirm your documentation was uploaded and received (or not).
When I spoke with Customer Disservice yesterday, they told me they never received my documents to substantiate my claim and that it's NOW past the deadline to file. The Customer Disservice Manager told me I'd have to appeal my claim and see what the Claims Disservice Manager for our employer decides.
I don't know what I'll do if they deny our claims. We were really counting on this money. It's about $850.
Any suggestions?

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Shrim
Council Bluffs, US
Feb 25, 2013 9:37 pm EST

There is no point in this service. The amount of money you "save" is wasted by the amount of time spent trying to get the appropriate documentation.

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awaldrum
dc, US
Jan 09, 2013 11:01 am EST

This has become the worst service ever. I also have found them refusing to pay claims more and more. My son was at the ER on New Years Eve and the hospital charged me the co-pay at the time and gave me a receipt. I submitted the receipt and they have refused to pay it demanding an itemized bill (which will not come unless I wait until the EOB (which I will not get until well after the grace period to file for 2012 reimbursement) and a statement saying that the $100 was a copay. When I asked for the list of details that they needed so I could send it directly to the hospital they said they could only give it on the phone, not by email and it was not on the website. I wanted something in writing because they have jerked me around on dependant care payments giving me a different list of "required" documentation each time I called. They could not even cite the reason they needed this host of information that they did not need before. I asked if I could fax in a copy of my insurance card which shows the copays for various vists they said no. This is the WORST customer service I have every received and they are a HORRIBLE company. I will NOT use them this next year and am meeting with our HR director this morning to talk to her about my ongoing problems with Payflex.

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aggravated1
Raleigh, US
Dec 30, 2012 11:22 am EST

Clearly there is a MAJOR problem here and no one of importance cares. My employer had so many complaints they finally decided on another service. Through our health insurance system United Health Care. My problem was with dental claims so we will see how this works out in 2013. Its a shame that they are allowed to give people the run around keep interest on my money. I do hold them responsible when I have met all their requirements and they were in error the person I finally got hold of stated that they did not understand why my claims were denied.

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HOTNSOUTH
housotn, US
Nov 27, 2012 7:49 pm EST
Verified customer This comment was posted by a verified customer. Learn more

PAYFLEX is not more compliant than other companies they are more RUDE that other companies AND its MY money they are being rude over .I am surprise what US citizens take from these companies .Payflex sent an so called notice -they docs were needed -It looked like a reimbursement ck that was expected like some CHEAP collection company .I got my Director of Benefits involved as this had been the most difficult time I Have EVER spent with an FSA company and especially over 4100 of my own money YOU ARE SO BUSTED PAYFLEX .Please write to your directors of benefits each and every incident you have .When fiscal year comes around NOT HONORING a contract is easy to switch to another company ...HOT at PAYFLEX 's RUDE condescending staff

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HighBloodPressure
Orlando, US
Aug 13, 2012 10:46 am EDT
Verified customer This comment was posted by a verified customer. Learn more

Something I found out today after getting endless lip service and phone run around by Payflex. I can't tell you how many time my card has been deactivated under the pretense that I failed to respond to mysterious letters that for unexplained reasons never reached my mailbox asking for documentation. If you click the place that says you would like to receive email notifications about payflex business it, without bothering to explain to you upfront, takes it upon itself to put in place the option to no longer send you letters in the mail requesting that you send documentation. It will however send you letters telling your account has been deactivated until you provide documentation. For years payflex has been sending emails requesting documentation to an old email address that has not been active. There is a page that you can get to on the worthless "HealthHub" where you can check off exactly which notifications will be sent to your email. When I was finally able to find this page the only box that was checked to receive email notifications about was the request for documentation. No where does it tell you that if you check this box payflex will not bother to attempt to contact you in any other way before deactivating your account. Also never was I ever given the option to choose which email notifications I would or would not choose so basically the option to not contact you by USPS is set up In their system as the default action if you're stupid enough to check off that you would like to receive email notifications.

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Seola1
Safety Harbor, US
Jun 18, 2012 4:29 pm EDT

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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Seola1
Safety Harbor, US
Jun 18, 2012 3:43 pm EDT

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.

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LB18
Dillsburg, US
May 21, 2012 9:31 am EDT

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?

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Randal B Goodrich
SLC, US
May 07, 2012 10:30 am EDT
Verified customer This comment was posted by a verified customer. Learn more

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!

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Randal B Goodrich
SLC, US
May 07, 2012 10:19 am EDT
Verified customer This comment was posted by a verified customer. Learn more

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.

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jtmuz
, US
Mar 07, 2012 4:18 pm EST

My experience has been absolutely HORRIBLE with PayFlex.

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hparsons
North Richland Hills, US
Nov 29, 2011 7:25 pm EST

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.

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Renib
, US
Mar 04, 2019 8:21 pm EST
Replying to comment of hparsons

I will be doing this repeatedly. My company is a fortune 500 company and if they screw with too many of us they will be out. We already talk about it at company social functions. I will recommend this course of action to all that I know who deal with these issues. Thank you

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DavisFAMILY
Mineral Wells, US
Oct 19, 2011 10:28 pm EDT

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.

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sierrani
coun, US
Oct 19, 2011 3:31 am EDT

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.

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Renib
, US
Mar 04, 2019 8:13 pm EST
Replying to comment of sierrani

Your rhetoric here is a tired version of earlier response and entirely inappropriate. If you work for the company then I will need to copy this and demand a decision as to why they refer to their consumers with name calling. I have had many problems with this company, least of which is the web site not allowing access. Seriously disturbing that I can not even log on to do business. If anyone is considering class action this is something that can be tracked. A bug you did not fix of this nature is irresponsible and name calling is a bully behavior. If you do not work there and I do believe you do then you need to curtail your responses to those that do not make you look like a bully trying to get away with something.

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mko1172
, US
Feb 07, 2020 1:49 pm EST
Replying to comment of Renib

If there is a class action suit, I want to be included. I am angry beyond belief for the hours/days I have spent JUST TRYING TO TALK WITH SOMEONE for the legitimate medical premium reimbursement as a retiree from my company, being hung up by them and no resolution after 4 months yet. I provided the documentation that I am still a Kaiser member and proof of my payments.

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Misha2
, US
Sep 30, 2011 11:04 pm EDT

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.

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Niki222
, US
Jul 27, 2011 8:13 pm EDT

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

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shane in ok
broken ar, US
Apr 09, 2011 8:41 pm EDT

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.

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Claudia Binder
Austin, US
Mar 18, 2011 1:25 am EDT

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

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A Fritz
El Dorado Hills, US
Feb 18, 2011 4:44 pm EST
Verified customer This comment was posted by a verified customer. Learn more

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.

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Ronald Bertswarth
Council Bluffs, US
Jan 21, 2011 7:28 am EST

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 [protected] 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.

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Ronald Bertswarth
Council Bluffs, US
Jan 21, 2011 7:26 am EST

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.

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Ronald Bertswarth
Council Bluffs, US
Jan 21, 2011 7:24 am EST

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.

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4kenchi
, US
Oct 15, 2019 8:45 pm EDT

Except in my situation when they have the itemized bill showing that my insurance paid "said" portion and what was left was what I paid. No, Ronald; they are highly unethical because I went back and looked. Not to mention I send everything as soon as I receive services and furthermore, I also verified via phone with them and they still turned around and locked my account-well after the fact. It seems like they wait until they are pretty sure people will no longer have receipts, then lock and request verification. Good thing I keep all receipts for seven years (scanning them to myself and keeping an accurate file). However, it is quite alright because PayFlex will be hearing from my litigator. To think, I attempted to handle by speaking with their cooperate office and the representative advised me that I had to speak to the department that handles my account in order to get that number; when I insisted, she then proceeded to "give me" the number, which was the same number I had just called and reached her. SMH; it is really sad what our country has come to. I do understand that a lot of this is due to those people who have deceived the government and insurance companies for years but being as I have never been that person, it is hard for me to empathize.

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John P. Gilles
, US
Aug 30, 2020 3:57 pm EDT

That doesnt give payflex permission to do such substandard work! I had them for an FSA, a charge would wind up being denied for some obscure reason, an NO notification was ever sent. You had to hunt and dig for the information on the last page, in the back of some paper from 10 years ago. Then surprise surprise the charge resubmitted goes right through...their customer service sucks, you gotta send in documentation for stuff as simple as a co-pay, then it's gotta be evaluated and approved. I tried to get a different fsa company, but discovered it had to be sponsored through my company. Horrendous customer service, saw a post where its mostly a mom & pop operation in some little podunk state, probably with only one traffic light in front of the general store!

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gc86
Wayne, US
Nov 18, 2010 7:36 pm EST

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.

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vickivb
Orlando, US
Aug 17, 2010 5:55 pm EDT

I don't think I'll have Payflex again!

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vickivb
Orlando, US
Aug 17, 2010 5:54 pm EDT

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.