Yup. big problems in that department. Most things are semi-automated. I do have it setup so that once a user is setup, they can boot into a rescue image, change the kernel, access the serial console, etc... without my help, though.
But, it is a pretty big problem if someone needs a new instance right away, or if someone needs an upgrade right away, and for system problems that don't hit my pager (though we're working on improving that one.)
Billing is not automated. I'm months overdue and I just got a personal email asking if I still wanted my account. It doesn't matter. Prgmr is hands down the best hobby VPS provider (I can't comment for other scenarios).
But, it is a pretty big problem if someone needs a new instance right away, or if someone needs an upgrade right away, and for system problems that don't hit my pager (though we're working on improving that one.)