PayFlexFailure to pay legitimate claims and faulty/fraudulent appeals process

I submitted EOBs to Payflex (administrator of my company's FSA) which were initially rejected, with a comment saying that I needed to submit the EOBs (which I already did). I filed an appeal with the same EOBs resubmitted, except this time I highlighted the amounts on the EOBs and wrote THEIR claim number on the EOBs for simple cross reference, chalking it up to a simple initial clerical error. In the appeal reason section, I put my explanation as well as my phone number to contact me if there was ANY additional information they needed to process my valid claim. After a week, I went back on the website and found that my appeal had been denied for the reason listed in the initial denial. No other explanation, no call, nothing. So I called their help line. It is a circular mess that takes 5+ minutes to get to a live person. They ask you to choose from a menu, including "Claims submissions" and a bunch of other completely unrelated topics. When you choose claims submission, they ask if you have submitted a claim the past 48 hours and if you say no, it takes you back to the main menu. If you say yes, it tells you claims should be processed in 48 hours. Finally I just waited and didn't dial or say anything, and it eventually took me to a live person. That live person was able to look at my account and determine that I had done everything right and she would resubmit it "as is" with a note to contact me if there was ANY problem. We'll see what happens with that. I am just a few days til the end of the year, and if I don't get all of the money in my account spent by 12/31 (MY MONEY THAT I PAID INTO THE SYSTEM!) I will lose my new HSA for the first three months of next year due to federal guidelines. Either way, their appeals process is an absolute fraud. I am heavily considering contacting a lawyer, and will definitely do so if I lose my ability to contribute to my HSA next year.

Dec 20, 2014

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