PayFlex: an FSA administrator actually does something right

By | January 29, 2009

UPDATE (June 30, 2013): I no longer believe this review from 2009 to be an accurate representation of the quality of service provided by PayFlex. Please see my more recent posting for an explanation. Feel free to post comments there; comments on the review here have been disabled.

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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32 thoughts on “PayFlex: an FSA administrator actually does something right

  1. Pingback: PayFlex gone bad? « Something better to do

  2. joeames

    I have been going back and fourth with them over 2 claims for months now and I have uploaded every document they want they review the documents and then tell me everything is good. When I check back I am told that after review they need something else or for some reason the documents that they claim to have received and reviewed are lost or did not save. The latest thing is they have told me to send them a check for the amounts in question and they would review everything. I have submitted more then enough doctors visits to compensate for the hold on the account and still they refuse to do anything. As far as the EOB goes I got them on the phone with a UHC rep and they told UHC what they needed and UHC sent that to me I uploaded it and I was told by another rep from payflex that the other rep was wrong and I should just resubmit the bill from the hospital (that would be the 3rd time I uploaded it) they may not get to keep the money in the end, but they are getting paid to service my FSA account and they just aren’t getting it done, I had my lawyer send them a letter this week I can’t wait to see if he gets any place with them.

  3. m

    I am glad I read this site because I am having a hard time getting my money from Payflex. First they tell me back in August 2012 that the reciept from my daycare is not itemized enough for them. It did not say “start of service and end of service.” It said starting balance with a date and ending balance with a date and the next reciept say start of service with the day after the ending date of the prior reciept. I can resolve the issue by having the day care sign a line on the reimburment form. After 7 faxes and 7 phone calls they final say they got a fax they would except in January 2013. When we get to the 15th of January I still have not had my money deposited. I call today and now they can not find the fax so I refax it today. They find the fax and now they say that they are in a “quiet period” and are not paying claims. They do not know why and do not know when it will be released. Based on the number of times I have called them they consider it harrassing and are planning on calling my employer to complain. I asked the superviser if waiting to get paid since August and now calling 3 times in 3 weeks was too much since they are constantly loosing my faxes and I still have not gotten paid. She said yes they need an opportunity to pay me. I told her if she can tell me when I would get my money I would stop calling until after that date, but I think I have been more than accomidating waiting for my money. I called my HR department. They said that they were told that the “quiet period” was over on January 11 and wanted to when Payflex told there was a “quiet period.” According to my HR department Payflex said there would be a “quiet period” until the 7 then it was extended to the 11. Maybe my company can get a straight answer from them. All I know is they have my money, I have done what they asked do, I still don’t know when I will see my money, they want to blame all they do on the IRS and can not tell you what IRS publications the information is in, oh yeah and they still have my money.

    1. jik Post author

      I’ve never had Payflex lose a fax I sent them. I can’t imagine why you’ve had a different experience. I wonder if you neglected to include a cover page with your name and identification number and your employer’s name on it. Anything is possible, of course, but given my experience with Payflex, I find it hard to imagine that they would lose seven faxes without a legitimate explanation.

      The “quiet period” is presumably so they can do close the books on 2012 for tax purposes. It’s not unreasonable.

      As for substantiation requirements, here you go:

  4. John

    You’ll never get an answer in writing (perhaps an email, but NEVER a letter) and they routinely reject typical doctor visit claims, presumably hoping that you’ll have discarded your receipts or determine it’s not worth the effort.

    These people shouldn’t be in the services industry, they should be in jail.

    1. jik Post author

      I am not really sure why it matters whether they correspond vie email or on paper. I personally prefer email. But in any case I’ve certainly received paper correspondence from them in the past.

      I’m not sure I’ve ever had a “typical doctor visit” questioned by them. Even if I have, I would have had no trouble scanning the receipt and uploading it to them, because I save all those receipts AS YOU ARE LEGALLY REQUIRED TO DO.

      If you can’t cope with saving receipts and providing them to the FSA administrator upon request, then you shouldn’t be participating in an FSA.

  5. bee

    Not happy with my pay flex plan either.they reject regular Dr. Bills causing me to have to take time out of an incredible busy schedule to resend and resubmit bills…even after they STOLE my 800.00 balance. Never once did I receive a statement ever about my balance. EVER WHY DON’T THEY SEND STATEMENTS …BECAUSE THEY ARE A RIP OFF.PAY FLEX IS A RIP OFF.

    1. jik Post author

      they reject regular Dr. Bills causing me to have to take time out of an incredible busy schedule to resend and resubmit bills…

      Since you’ve said nothing about why your bills were rejected, we have no way to evaluate the validity of your complaint. Judging from the cluelessness displayed in the rest of your comment, I think it’s more likely that you are doing things wrong than that PayFlex is.

      I’ve been using a PayFlex FSA for three years now, and I think in all that time, they’ve only incorrectly rejected two claims, and one of those was in sufficiently confusing circumstances that I don’t blame them for it.

      One claim that PayFlex rejected was not only correct, it even led me to discover that a doctor had double-billed me for a copayment, so the PayFlex rejection actually saved me money.

      As several other commenters have noted, PayFlex does not set the rules for what documentation is required to substantiate claims; the IRS does. Blaming PayFlex for enforcing rules that it did not make and cannot change is at best unfair, and at worst just plain stupid.

      even after they STOLE my 800.00 balance. Never once did I receive a statement ever about my balance. EVER WHY DON’T THEY SEND STATEMENTS …BECAUSE THEY ARE A RIP OFF.PAY FLEX IS A RIP OFF.

      PayFlex didn’t steal anything from you.

      You chose through your employer how much money to put into your FSA account. It is your responsibility to keep track of it.

      You were told when you signed up for your FSA, or should have been, that any unused balance is forfeited at the end of the plan year.

      Your balance is easily available for you to view on the PayFlex web site any time you want to go look at it.

      Every time you file a claim with PayFlex, you receive an EOB which tells you how much of your balance is left.

      If your employer is anything like mine, you received multiple warnings after the close of the plan year that you needed to use up your remaining balance or it would be forfeited. I’m not sure, but I think PayFlex even sends you such reminders if you give them your email address. (I’m not sure, because I delete these reminders too quickly for them to stick in my brain, because I have enough of a clue to know long before they tell me that I need to use up my FSA funds or I’m going to lose them.)

      If your forfeited money in your FSA account at the end of the year, you have only yourself to blame, and you’ve got no right to blame PayFlex for your own stupidity.

      1. Seola

        Perhaps before you jump to conclusions, you might want to realize that PayFlex locks cards up, even after denials or during their own admitted time of “reviews” or even, yes after accepting documentation. When they lock this card it can take weeks or even months, and have routinely locked the payment cards for years old claims after someone makes a complaint. Some are having cards locked from 2-3 years ago. After it’s locked up, and you can’t use it before the expiring period, they get to keep your cash. I’ve never, ever had so many denials, including directly from a hospital, with a charge through of surgery directly attached to the charge. It’s absurd. Now that I’ve submitted documentation, it’s not good enough. So I’m locked, yet again, in another cycle of trying to prove my case or I get to send in a check for legitimate payments and start this all over. Personally, we’ve been with them only 6 months with my husband’s new job. I’d rather pay cash and keep the receipts myself because the IRS has no problem with my documentation. An extra pain to itemize? Perhaps, but I’ve already spent, in 6 months on more than a dozen rejections, about 35 hours dealing with it all.

        1. jik Post author

          I can’t say why your experience has, according to you, been so much worse than mine. All I can say is that I’ve never, not once, had my card locked up.

          I am also extremely puzzled by your claim that your card has gotten locked up as a result of 2-3 year old claims. As far as I know, FSAs are annual, and all expenses for the prior FSA period must be submitted within a few months, or six months at most, after the end of the period. So I am completely unable to understand how you could be submitting an expense for 2 or more years ago.

          Oh, and quite frankly, if you’re submitting expenses from 2-3 years ago, then you’re sort of by definition part of the problem. You’ll have a heck of a lot less trouble, and save everybody else trouble as well, if you submit expenses in a timely fashion.

          Also, it’s not true that you lose your money if your card is locked at the end of the FSA period… You can pay out of pocket and submit the expenses to Payflex for reimbursement, a process which has nothing to do with your card.

        2. CSR

          It seems to me that your the one that has jumped to conclusions as you seem to know nothing about FSA accounts and the IRS rules.
          1. The IRS requires FSA administrators to lock up the cards if the account has not been reimbursed for a claim that was not substantiated. So if your card got locked up 2-3 years later, count yourself lucky that you got to use your card for that 2-3 year period when it should have been locked within 90 days of your failure to substantiate the claim.
          2. Just because you have a surgery at a hospital does not mean it is a qualifying expense. Not all surgeries are eligible. Is the documentation your sending in specific? Does it show a description of the services, the charges and what your insurance paid or is it a statement that just says you owe ##.## and that it was billed to your insurance? Those statements do not show liability nor does it prove that you didn’t spend that money in the gift shop or on liposuction.
          3. Payflex of any FSA administrator does not get to keep your money if it is forfeited, your employer does, so payflex has no motive in keeping “your” money (although it’s not technically your money since you didn’t pay taxes on it according to the IRS).

          I have worked for a FSA administrator for a few years, and I am dumbfounded how difficult some participants make this whole process. When you get a letter requesting documentation, send in a EOB, most insurance companies will allow you to get these from their websites. If for some reason your technically challenged, then contact your provider and get an itemized receipt, not a credit card transaction receipt. The itemized receipt needs to show a description of the services, the charged amounts and what your insurance paid (not an estimate of what they are going to pay).

  6. Unhappy with Payflex

    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.

  7. Barbara Snow

    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.

  8. Finito

    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.

    1. Ronald Bertswarth

      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.

      1. Seola

        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.

        1. jik Post author

          If you have some proof of the accusation made here, such as links to comments that Ronald has posted elsewhere, I would like to see them.

          Having said that, they would not prove that Ronald is posting astroturf on behalf of Payflex, since my experience and understanding are consistent with his, and I certainly don’t work for Payflex.

  9. jik Post author

    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.

  10. Joshua

    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.

  11. sab

    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???

    1. JustEric

      I know your post is over two years old, but a point of order: at the time of your post, they did NOT have $1,200 of your money. AT MOST they had $400 (and it was probably closer to $300).

      The way PayFlex works is you have a set amount you can spend per year. In your case, it appears to be $1,200. You can spend all of it on day 1, or none of it until day 365, so that total balance is available to you at the beginning of the year (in fact, unless January 1st is a pay day, for a few days they have NONE of your money, but you can spend $1,200 of theirs).

      Over the course of the year, small chunks are taken out of your paycheck and given to PayFlex to “pay back” this “loan” of sorts that they’ve given you (it becomes more like a loan the more you spend and go over your contributed amount).

      With a total annual amount of $1,200, your contribution is a nice, clean $100/month. Since you posted in April, you had only contributed for a little over 3 months, hence the $300-400 estimate.

      Also, I sincerely doubt that you could not access that money. Pay your copays, pay for your meds, and submit a claim. You’ll get your money back.

  12. dm

    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.

    1. jik Post author

      Did you report the problem to them? What did they say?

  13. jik Post author

    @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.

  14. richard

    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.

    1. JustEric

      If your employees have IQs above room temperature, you should be fine with PayFlex. If you work with a bunch of mouth-breathers, I’m not sure you’d be okay with any FSA, let alone PayFlex.

  15. Will

    It’s too bad; their website now rejects every PDF as being invalid.

    1. jik Post author

      Since when? I successfully submitted a PDF as recently as February 10.

  16. Steph

    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.

  17. jik Post author

    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.

  18. Lyn Johnson

    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.

  19. Lyn Johnson

    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.

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