I had the same claim for the same provider approved in 2016 and 2017, but denied in 2018. Exact same service provided. Appeal made. PayFlex dragged their feet, couldn't find the prior approvals, and then simply said that it didn't meet IRS guidelines. Somehow the prior two years did? In any case, the one and only reason I funded the account in 2018 was to pay this expense. Now that money is gone, supposedly to cover "administrative costs." What is the business model here anyway? The more denials the more money PayFlex pockets? If that's the case there's a serious case of conflict of interest here. And incompetence, or feigned incompetence since competence would arrive at solutions.