As of the beginning of the year, my employer is using PayFlex Systems to administer their healthcare flexible spending account (FSA).
My experience in the past with third-party FSA administrators has ranged from mediocre to bad. However, this time I’m writing to give kudos, because when I went today to submit my first claim through PayFlex’s self-service Web site, I discovered that they have an intelligent, well-designed, innovative claim submission process, the kind that makes you say, “Why the heck can’t everybody do things this way?”
When you log into the Web site and click “Express Claims”, you are immediately brought to a screen where you enter the details of each charge you’re submitting (expense type, date, amount). The data entry form is intuitive and responsive, and it doesn’t make you fill out the fields that aren’t needed.
When you’re done and click “Submit”, you are brought to a confirmation screen where you can review all of the information you entered and go back to correct any mistakes.
This is cool. You are entering your data directly into their database, which means that transcription errors and data-entry delays are eliminated. Furthermore, since they don’t have to pay people to do data entry, their costs are presumably lower, and one would hope that the cost savings is passed on to my employer in the form of lower administrative fees.
But that’s not even the coolest thing. Once you confirm that all of the information is correct, you arrive at the receipt submission screen. They offer you the choice between faxing in your receipts and uploading them as a PDF file produced by a scanner. Since scanners are common nowadays and pretty much every scanner can produce PDFs, uploading a PDF is less trouble for many people than faxing. Furthermore, the uploaded file is linked immediately and automatically to the claim, once again reducing both delays and processing costs.
Of course, PayFlex also offers the option of filling out a claim form on paper and submitting it by mail or fax, so people who don’t feel comfortable using the online process can still submit claims.
For more information about PayFlex’s claim submission process, see their FAQ page.
Nice job, PayFlex!
UPDATE: I received an explanation of benefits from PayFlex via email, indicating that my claim had been paid, less than 15 hours after I filed my claim. Wow!
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Repeatedly, Payflex has made mistakes forwarding correct information regarding my health care policy to United Healthcare while I am on leave. Their regular incompetence has led them to direct my health care carrier to terminate my health policy on two occasions in the past 2 1/2 years. Getting the policy reinstated is always very time consuming on my part and Payflex refuses to accept any responsibility or make corrections to keep the same thing from happening in the future but directs all the blame on the health care insurance company. I have found Payflex to be overall incompetent in their duties that should be considered very seriously and done with scrutiny.
I too have had nothing but trouble with PayFlex. It turns out my doctors don’t write their bills the way PayFlex wants them, the hospital doesn’t provide the right kind of receipts and since I can’t whip Blue Cross Blue Shield into line, their documentation is not useful either. I hate it.
My interactions with Payflex this year have consistently been some of the most frustrating and infuriating of any customer service experience. Ever. For any reason. Apparently I am going to lose the almost $2000 balance. If you are considering signing up for Payflex, you might want to ask yourself: if your front teeth were knocked out in an accident, and you had set aside money out of every paycheck into an FSA for just such an emergency, would you expect that having your front teeth knocked would be a reimbursable expense. If you answered Yes, DO NOT sign up for Payflex. Apparently they think front teeth are optional. Worst company ever.
That Joshua poster must work for Payflex.
Finito, yes that Joshua poster must work for PayFlex because he actually has facts and references on hand and actually makes sense unlike most of the complainers here.
PayFlex does not set the rules on what’s reimbursable and what isn’t; that’s the IRS, and you should know that by now, so to take your frustration out on PayFlex is absurd. With that said, dental implants are FSA eligible and if your claim was denied for implants then I would exercise your option to appeal the denied claim. If you paid for cosmetic veneers, then the IRS does not consider that eligible and thus your claim would be denied.
You should check out IRS publication 502 and 969 as I did after reading Joshua’s post; they’re quite informative.
I was having a lot of trouble with PayFlex rejecting my PDFs when I was using FireFox on my MacBook. I switched to IE on a Dell and now it works fine. I think PayFlex might either have a browser issue or a Mac/Windows issue. Hope that helps.
I just successfully uploaded a PDF to Payflex using Firefox 3.6 on a Mac.
Just FYI people, per IRS publication 969 and 125, ALL reimbursements MUST be substantiated BEFORE reimbursement is given. When you use your debit card, you are receiving immediate reimbursement and if the transaction cannot be automatically substantiated through the merchant’s IIAS (Inventory Information Approval System, which affects ALL FSA debit cards), then per publication 969 and 125, the administrator is required to request the documentation to substantiate the claim. If it is not substantiated and the IRS audits the administrator, they are fined heavily if they don’t ensure IRS compliance.
Also, some of you have mentioned the card being inactivated due to overpayments from providers. Per IRS regulations, all reimbursements must be made based on final patient liability. This is how much you owe AFTER any discounts, credits, adjustments or insurance payments for example. If you’re paying your dentist for example based on an ESTIMATE of what your insurance will pay, that is not eligible for reimbursement under IRS guidelines, so why is it fair to PayFlex to allow them to be fined by the IRS for your negligence in using the card improperly??
Also I have noticed a lot of complaints about “not being notified” of documentation request letters, however, as a PayFlex cardholder myself, I have opted into their eNotify service which emails my documents to me rather than by paper mail. This is great. It’s faster and more convenient, and if I change my email address and I don’t receive my notification, who’s fault is that? Certainly not PayFlex’s as they’re just sending the letters to the place I told them to. If you’re not getting them by mail, I would suggest you complain to your post office.
PayFlex is through my husband’s employer–nothing but trouble this year!!!!!! what a joke!!!!!!
We have done everything they have told us and still have a hold on the card – could not pay for my prescriptions with it today!!!
It seems like our doctor overcharged on a fee and therefore $88.00 did not qualify. When we were at KU (regular visit-go every 6 weeks) last week the card was denied when I paid for the visit-paid with debit card. Then card was again denied at the pharmacy-paid with debit card.
Contacted PayFlex and they stated since the doctor overcharged they had put a hold on our account. We faxed them in the documentation that we just spent over $90.00 out of pocket which would offset this doctor’s filing problem. They said 48 hours we should be able to use my card. Well it has been one week later and I just tried and it was again denied.
Now they tell us they never received the fax of the documentation that we had spent the $90.00 out of pocket—my husband faxed it as he was talking to them.
If we could get out of this company we would but we cannot for one year!!! In the meantime they have $1200.00 of our dollars!!!!!!!! which we cannot seem to access!!!!!!!!!!!
I WOULDNOT recommend this company to anyone–I have also understood from our pharmacy what happened to me tonight has happened to many of their clients on PayFlex.
Last year in 2009, we used the card without any of this–they tell us now it is because of the government changing regulations.
So who do I contact to really complain??? Insurance commissioner–government office???
I was having a lot of trouble with PayFlex rejecting my PDFs when I was using FireFox on my MacBook. I switched to IE on a Dell and now it works fine. I think PayFlex might either have a browser issue or a Mac/Windows issue. Hope that helps.
Did you report the problem to them? What did they say?
@Will: I just successfully submitted a PDF of a receipt through their Web site. I’ve never had trouble submitting a PDF. I don’t know why their Web site rejects your PDFs as being invalid, but I think you might have better luck finding out by calling them on the phone and asking for their help rather than posting comments on blogs about it.
Interesting. Sounds like you either love them or hate them. I am looking for a new FSA administrator, and was going to include them. Now not so sure.
It’s too bad; their website now rejects every PDF as being invalid.
Since when? I successfully submitted a PDF as recently as February 10.
Payflex is horrible!!! PLEASE someone find a senator or congressmen that would be able to help us get these people in line. Anyone know of how to make these people be more reliable? They don’t care and yet they have our money.
Wow. I’m sorry you’ve had so much trouble. I must say that my experience has been entirely different. We’ve never had a problem using our debit card, or submitting PDF files through their Web site, and we’ve never been asked to provide documentation for a valid FSA charge we put on the debit card.
Tag: FSA, PayFlex
At some point during 2009, PayFlex no longer accepts computer files (according to person I spoke to last week 11/09). DO NOT TRUST THEIR FAX SYSTEM. Documents faxed do not go to a fax machine, but directly into the computer system. The system kicks out random pages and even though your cover page says 1 of 5 pages, and your fax journal says 5 pages were sent they will claim not to have received some (and sometimes all) of the documentation you sent. THEY DO NOT NOTIFY YOU IF ALL PAGES SENT WERE NOT RECEIVED…or as they say, “kicked out”. We have had to send the same documentation time and time again. Yet when we log on to mypayflex, it shows the documentation was received the first time it was faxed.
Tags: FSA, PayFlex
Glad you like PayFlex. I wonder if it is still true now that the year is at an end.
We started with PayFlex in January 2008 and have had nothing but problems. Each person you talk to at PayFlex gives you a different story as to why your card is inactive, requests for documents supposedly have been sent but never received by us, we now “owe” PayFlex $118 for 2008 expenses which came up as denied when they recently audited the account. It is too late to submit documentation for those expenses…of course, the supposed audit occurred months after the deadline to submit documentation had passed. We have spent many, many hours on the phone with PayFlex and our card is always inactive, unbekownst to us until we go to use it. Every time the card is inactive and I call to ask why, there is always an “audit” that has supposedly occurred. In the end, we have decided not to have an FSA account for 2010 as it costs much more time in phone calls and re-sending documentation because their system “kicked out” one or more pages. Their answer is that we are to be monitoring our account continuously through mypayflex, and if we don’t, it’s not their responsibility that we have not received requests for documentation, that our card is inactive and we have not been notified, and on and on. Their other excuse is that the mess is caused by IRS regulations. Prior to having PayFlex, the company used WorkFlex. We never, ever had one single problem with WorkFlex. When they changed over to PayFlex in Jan. 2008, we heard (from other people who had PayFlex) nothing by complaints. After being with them for 2 years, we’ve had it. Would rather pay the taxes on the money than the hassle of dealing with them. They claim we owe them $118 (2008) for 4 medical visits (which are actually prescriptins) and 1 prescription which is actually a medical visit. You can talk to 5 different people in one day, in a matter of hours really, and you will get 5 different amounts of discrepancies. Apparently no one at PayFlex is looking at the same data when you call.
Our card is currently inactive, of course. We are not going to have it re-activated, but simply pay the bills ourselves and then submit claims to PayFlex for the last 2 months of 2009.
If you’ve had good luck with PayFlex, from our personal experience and from what we’ve heard from others, you one a very few lucky ones.