Confirmation Emails Not Sending When Approvals are Required


I'm using APpointments + on this site :

Initially we had the site set to auto confirm appointments. When that was the setting - users were receiving the confirmation email and the admin was receiving the confirmation too.

When we switched it to no longer auto confirm - I noticed a few strange things :

1 - If I was the person submitting a request - I didn't receive an email acknowledging my appointment
2 - The meeting did go into the pending folder BUT the admin never received an email confirmation of the pending appointment.
3 - Changing the status of the appointment to confirmed did change the status, but checking the box to send an email didn't work.
4 - I have some meetings that ended up in the removed tab and I can't understand why.

Is there something I'm overlooking regarding the email confirmations?