I purchased Aflac 2 years ago and never filed a claim until a few months ago. I had to see a Cardiologist... office visit $500... he did tests... and I had one trip to the Emergency room where the Cardiologist administered a medicine to Reset my heart. All of this totaling $8,000. Aflac paid me my $25 x 4 for Dr. Visits I did not use for the 2 years and a Big Kiss my @$$ for the rest of the bill. They are NOT going to cover me for anything more than the $100 because they said that they do not pay for tests and xrays???!!! WHAT? It took those tests to figure out what the problem was BEFORE it became something Major.
COLUMBUS, GEORGIA -- My policy originally began on 9/12/12. Due to mishandling of my policies, both were terminated sometime in Feb. 2013 and then reactivated in March 5th 2013. On June 18th, I was informed by an AFLAC representative ** that both of my policies were again inactive/terminated. Caller stated it was because no payment was received for March, April, and May. I was advised to call my employer.
I spoke to the Human Resources Director at Wellington Retreat on this date, who informed me that they have proof of invoices paid to AFLAC through 4/1/13. Furthermore, she called AFLAC **, again payment on their end was verified. Please note: that on March 18th, I called into AFLAC and enrolled in AFLAC ALWAYS. I provided a VISA credit card and was ensured that payment deductions would be taken once my employer made their last invoice payment, which should have been in April's invoice. To my knowledge, payment was being made on my VISA. I have documentation to prove this.
I also spoke to a supervisor at AFLAC customer service, Mr. ** on this date, in attempts to gather more data. He stated that my credit card information was removed from the system and therefore, my policy was terminated. Please be advised: I NEVER REMOVED MY CREDIT CARD INFORMATION. In addition, this is contradictory of my previous call to AFLAC as stated above. I am currently 24 weeks pregnant and was depending on the moneys I would receive through my short term disability policy. At this time, I have no policy.
Lastly, I spoke with **, who is an AFLAC representative that originally enrolled me in these policies. She is aware of the continuous mishandling of my health care and offered me apology on behalf of AFLAC. This company has caused me a tremendous amount of unnecessary stress to both me and my unborn child. Furthermore, I do not feel comfortable having my health care in your hands.
At this time, I am requesting a FULL REFUND of payments provided to you since 9/2012. I have paid you a few hundred dollars and have had my policy inactive throughout most of the time. The constant confusion and mishandling has led me to believe that this company is not representing themselves as promised. I will not pay for something I never received, nor do I feel I should be held liable for your mishandling.
I have documents and proof that indicate I took the necessary actions to ensure my policy remain active. Also, I never received any kind of notice from AFLAC that my policy would be terminated. I do not want my policy active at this time, as I do not feel comfortable placing my health in the hands of this company.
On 6/27/13, I spoke with Escalation Services, who informed me that my request has been DENIED. My refund in the amount of $560.45 is being denied stating that, “I could have filed a claim.” The fact is, I couldn't have filed a claim because my policies were inactive most of the time I supposedly had them. Furthermore, they stated “they apologize that the system failed and did not register my Visa Credit Card and therefore, my account was terminated.
So because their system was not operating correctly, they have taken all of my money and have left me with no coverage for my short term disability (maternity leave). This company stole my money and did not provide me with any services.
COLUMBUS, GEORGIA -- As an agent for almost ten years, there are two problems here. One is individuals not understanding their initial waiting periods. To solve this I created a label that I put on the front of my brochures that states Effective date plus 30 day wait = This date for new diagnosis. Pre Existing wait is either six months or one year depending on the plan. This is on all plans that have sickness benefits. The accident plan does not have a wait and the Dental has a different type of waiting period.
I explain to my clients that if you go to a Dr before the 30 day wait and they test for symptoms, even if those test results come back after your waiting period is up, you were still tested for a new condition prior and it will be denied. I do not tell people not to go to the doctor, I tell them they are not covered until after the 30 day wait or pre ex wait.
And the problem with pended claims is pretty simple to fix also. AFLAC requires a basic claim form with your information, and a release form. Then you need to provide proof of treatment for your situation. It is cut and dry and one trip to the hospital Medical Records Dept will yield the needed papers.
A hospital overnight stay requires an Itemized Hospital Bill, an MRI requires an MRI report, a surgery requires the surgery report, etc. AND ALL CLAIMS NEED TO INCLUDE THE DISCHARGE SUMMARY REPORT WITH DIAGNOSIS CODE. Otherwise, you have to get a Dr's signature to verify the diagnosis. This form is available from Medical Records. This means the ONLY form that now must have a Dr's signature is your Short Term Disability form.
Most pended claims are because of insufficient information. HIPPA regulations require you to obtain this info for faster claims processing. If you were hospitalized and have surgery, please submit an itemized hospital bill, surgery report and the Discharge Summary Report with diagnosis code and the claim form and release form and you will find your claim will be quickly paid.
AFLAC also has an claims appeals board that I have had approval through for those unusual situations. Finally, remember your Health Insurance company does not pay YOU cash. AFLAC does and my clients are very happy with their AFLAC experience because I stress the effective dates when they purchase. I hope this post helps someone to know how to file their claims now.
We have paid for our "Accident/Disability Policy" with Aflac since 2/08. Our "Type of policy" is described as "Named Insured/Spouse" as we pay additional to cover my wife. I was told by the Aflac representative that with the additional fee, my wife would be covered as I was. Along with that we have two additional riders described as "Off-the-job accident disability benefit rider and Sickness disability benefit rider."
We were lead to believe that we both had the same coverage and shared the same benefits of the policy. In reading the very "in depth" (we'll call it) policy, one finds that the policy is mostly written in the wording for an individual policy and it would be just that if not for additional riders and fees to cover more, such as that of an additional family member.
The section describing "Type of Coverage" reads "see your Policy Schedule to determine the Type of Coverage issued: Individual, Named Insured/Spouse Only, One-Parent Family, or Two-Parent Family." Under the description for "Named Insured/spouse" the definition reads "coverage for only you (the Insured) and your spouse."
The "Policy Schedule" shows "My Name" as the insured. I understood this to mean the "Main policy holder" and nothing more. I mean.. it's got to be under someone's name. Does it not?? The important part for me is that my wife is covered as well. It appears she is as described under "Type of coverage - Named insured/Spouse" to be found on the very next line.
With all these statements in the policy we had no reason to think my wife doesn't share in all the same benefits of the policy that I would. Especially since we pay additional to have her on the policy. Recently, my wife took ill and spent 9 days in the hospital at a cost of almost 250k to date, paid mostly by another insurer thank goodness. She had two weeks of recovery time at home and off of work. We filed a claim with Aflac under the "Sickness rider" and the claim was denied with the simple explanation that "my wife was not covered under the policy riders."
To look at and see these policy documents, there is no reason at all to think she would not be covered. Then you come to the Rider and their coverage. "This rider applies to the Insured only, as shown in the Policy Schedule." Yes... I saw this. Still I thought that with the additions on the policy that it included my wife as described in "type of coverage" and as described to me by the Aflac rep. I was wrong.
A layman and simple person has no chance against some insurance companies that are out there and we feel very deceived and flat out ripped off by Aflac. We can't and will no longer recommend Aflac as a reputable company and our hope is that others will see this deception before it's too late.
Obviously, due to the extremity of my wife's illness we are now financially devastated and will work the rest of our lives (shes 40, I'm 45) to pay this off. The failure of Aflac to come through for us and help offset at least a very small portion of the amount we now owe just leaves us that much more in debt and that much more of a struggle to pay the bills.
22 CORPORATE WOODS, SUITE 2, ALBANY, NEW YORK -- On 5/23/2009 I was scheduled and had surgery on my wrist. I am an RN supervisor and have two daughters that I support entirely on my own. I took out the Aflac insurance because a friend of mine had cancer and I was concerned about my children and their future, should this ever happen to me. I took out every policy Aflac offered through my work, disability, cancer, accident, life insurance. Needless to say, this costs quite a bit of money each pay period; I had thought this a small price to pay for mine and my children's piece of mind.
I had verified prior to my surgery with Aflac that all was covered for my surgery for disability. My surgery could have waited, which I would have done had I known that they would hold up my payment as they had. I filled out all of my paperwork as requested, followed up a week after doing so to give them adequate time to process them. I was told at this time that they would be requesting further information from my surgeon to establish that this was not a pre-existing condition. I completely understood the need to verify so and was not concerned. They also stated at that time that I would be receiving a copy of this request as well, I did not.
After allowing them another week to send out, am my surgeon's office to receive this request; I called my surgeon's office to verify that it was being processed, or would be shortly. They informed me that they had never received such request for additional information. I as well had not received the copy of this request as stated I would. I notified Aflac of this and was told that a request had not in fact gone out when I was told, but rather just the day prior to this phone call. Patiently, I waited again...
Yet again, no request had been received by either myself or my surgeon's office. I called after another five days to yet again allow them sufficient time to process this request. Upon speaking to the Aflac representative I was informed that the request had not gone out on either prior dates specified, but rather had been faxed - on an entirely different date than I had been given previously.
Again the waiting game, I am now at this point three weeks into my disability and have not received a single piece of paper, let alone a check from Aflac. I at this point make an attempt for some assistance and place, not one, but two phone calls to the insurance representative that had sold me the Aflac policies through my work. These two calls were over a three day period. I did not receive a return phone call from this agent.
I then contacted this agent's supervisor who stated she would look into it and get back to me. Meanwhile, my doctor's office was kind enough to fax to Aflac the requested information that they had verbalized to me that they needed. This was done on two different occasions, both showing fax transmittal forms that verified they had been received at the correct number. Of course, Aflac said that they never received this paperwork on either occasion that it had been faxed.
At this point in my very stressful recovery, I am now at six weeks with no check from Aflac and not much hope of seeing one. My doctor's appointment was scheduled for two weeks from that point. I was now forced to go to my surgeon and request that he remove the cast from my arm earlier than expected and practically beg to go back to work. I am extremely fortunate that I as a supervisor have a different workload than that of many other people. He reluctantly agreed with some stipulations.
My first day back was on a Saturday, last day of a pay period. I hadn't been thinking and should never had returned then, Aflac removed their premium from my check off on days work - after taxes and insurance leaving me $14.00!! Not enough for a tank of gas.
I found that on my first day back to work, Aflac cut me a check for one week! Not the remaining five, just one. Upon return to work I let all employees know via email and bulletins what Aflac had done to me. Next thing I know I have the district manager in telling me he will clear up this issue. Apparently, out of the 450 employees; numerous ones chose to cancel or not take out their policies as planned.
Needless to say, I have now been back to work for two weeks and have still not seen another check for the remaining funds owed to me. They of course have removed all of their fees for their insurance. The district manager has told me that they have all of my information and that they will process it within 14 days with a mailing time of 7 days.
So the bottom line is this, I will have received my disability payments five weeks after returning to work. GOOD THING I HAD DISABILITY INSURANCE!!! Words cannot describe my disappointment and sheer amazement at Aflac's irresponsibility. I truly felt a piece of mind when taking out the policy, that I am my children would be covered should something happen. This was so very untrue! Please be a wise consumer and consider this before signing up for this insurance service. I did the right thing and should not have had to suffer through this nightmare!
GEORGIA -- My fiancé purchase Aflac's Critical Care Plan on his job as a supplemental insurance, the agent explain to employees that if they considered this policy it would pay $20,000 if they ever experience one of the following: Heart Attack, Stroke, Cancer and Organ Transplant. Well after having the policy for 4 year on December 2014 he had to have a pacemaker implanted in him due to the fact of him having complete heart block, or AV Block.
After his stay in the hospital we filed the Critical Care claim, at first we were thinking that in a couple of days (as little as 3 days, what a lie!) he would receive a check. We contacted Aflac after two week pass and were told that they needed more information; the usual paperwork needed so that the claim could be paid. We provided every item they requested and was assured that we would get a check in the mail totaling $20,000.
The next week we received a check Wellness check for $50, and afterward a letter arrived requesting more paperwork. I went here and there to retrieve what they said was needed, sent it in and waited. In about week we receive a letter stating that the claim would be denied base on the policy only covering him if he had actual had a serious heart attack that left him half dead.
I question them stating that his life was saved due to the emergency surgery and the pacemaker put in, I was then told "that he is not eligible for payment based upon the doctor was able to sustain his life" and we should be thankful. I then ask the agent what would have happen if he had died, she then told me that "there would be no need to file the claim if he had died he would not be critical."
We have submitted 2 claim forms stating that he had a MI, the doctor refuse to change it Aflac somehow contacted the doctor's office and they changed the claim form after 2 months. It is things like this that "BIG" insurance company depend on to help them practice "BAD FAITH." Nothing like have proof for your records.
I have received 20 letters explaining to me why the policy can not be paid, 1st we were told he didn't have a heart attack, to the point of he did not have a Myocardial Infarction but just a simple AV Block. We went back and forth and each time they use these same excuses. I contacted the GA Commission of Insurance and filed a claim against Aflac, of course they would agree with the bigger company rather than the little people.
So we have been going it alone with Aflac, one thing Aflac don't realize that people read and study - that's what I did concerning his diagnose and the medical terminology states that in order to have a Complete heart block, AV block or a 3rd Degree block a Myocardial Infarction would have had to occur.
We will hold firm to the claim regardless of how the doctors, GA Insurance Commission and Aflac work together. I have sent letters asking why the policy was denied when it meets all the qualification on the policy. What they sent to use was "Aflac will only pay for Myocardial Infarction or a Heart Attack" - this was mailed to us and highlighted.
I went to the medical website and looked up AV Block and what cause it and it stated that it was cause by one of two Myocardial Infarction, the seriously one requiring pacemaker to live. I too highlighted this and sent it to them, not sure what my outcome will be, regardless we will fight until Aflac pays to have the medical terminology changed. My fiancé has not return to work and we have doctor's bills coming from left to right. One thing I am proud to say is that his primary insurance company (BCBS) is true to the words, that's why they don't have to put "fake" advertisements on television.
It is our perceptions that Aflac never really intend to pay for these claim, they might pay small claims, but large claim they give the client the run around in hope that the client will roll over and take their tactics. Why pay for a claim and when you really need it, they find all kind of made up excuses to not pay.
DALLAS, TEXAS -- I signed up for Insurance in December and tried to cancel because I realized I have to pay out of pocket first and then they will reimburse me and I just didn't have the upfront cash. The first time I called and cancelled it wasn't done. The second time I called to cancel they said they didn't see any notes of me canceling and charged me. Told me in order to get that money back I would have to fax them a letter stating what happened.
I decided it was too much of a hassle and forget it. It was just $30. Then I was charged the 3rd month and when I called and explained everything all over again they told me this time they had notes and would send me a refund check. They never explained that I would need to send a signed written note again. A week or two later (now) they send me a letter instead of my money saying that I have to send them a signed written authorization to verify that I want to cancel. What?
Was my word of mouth over the phone 3 times not good enough? Did the fact that I gave them all the security information they needed to know that I am the policy holder? Did I not already give you over $200 a month that I never used? And you are telling me you can refund me back my lousy $30 (only by check, of course).
They make it very easy by going through your bank and having all access to your account to take my $30 monthly but when you want your money from a mistake that they made you have to go through a process. This is the worst service I have ever had and I will tell my company that employs over 300 people, that let them come in monthly and offer their services, to not receive anymore services from this company because of the turmoil they will take you through. It is cheaper and the customer service is better with a real insurance company and less of a hassle!
PORTLAND, OREGON -- I am 66 yrs of age, and never before felt compelled to enter any type of complaint. That cute little duck represents the largest ripoff company known to man. My deceased wife purchased a cancer policy two years prior to her diagnosis of colon cancer.
Everyone 'thinks' they have good insurance -- until they have a claim. If you are contemplating buying an Aflac policy (God forbid) before buying, pretend you have a claim -- and call the so called 'claim hotline.' You will get a recording (eventually) -- and they will send you a form to submit. During my wife's illness -- we submitted 54 claims. NONE repeat None were honored in a routine manner.
Typically you will receive a form 'requesting more information'. Then they will request an explanation from your doctor. To further 'discourage' the policy holder -- they break down the claims -- (less than $200). EACH separate claim must have course be reviewed by your physician. Just what a harried doctor wishes to do -- file 8 pages (average) -- SO understandably these forms tend to get buried in the 'IN FILE'. AFLAC IS WELL AWARE OF THIS -- and will go to any length -- stall -- more information required -- anything but honor claim.
I REPEAT we filed 54 claims -- not ONE was handled routinely. MY wife had many chemo treatments. These typically cost about 3-5 thousand each. If you take the time to read the 'very small print -- you will see that several chemicals are excluded from your policy. The bottom line, when you file for your claim -- you will discover that your 'insurance' is good for an average of $250 on each treatment. In the meantime, the insured and their loved ones are becoming 'stressed out' -- Aflac is obviously aware of this -- and the more paper work the better.
Finally, I WENT TO OUR STATE INSURANCE COMMISSIONER and we did eventually receive about $4,000 dollars. All my loved ones expenses totaled over $500,000. We were fortunate to have EXCELLENT PRIMARY INSURANCE -- so we were able to 'weather the storm' better than most.
I WISH THIS RIP-OFF FIRM WOULD SUE ME FOR SLANDER -- I would much like to 'speak my piece' in a public forum. I INCLUDE MY real e-mail -- If any of you need a witness, or statement verification -- pls. so indicate -- I will, at my expense, travel to testify.
COLUMBUS, GEORGIA -- 3 years ago I took out 2 Aflac policies. After never using them I decided not to renew the policies. I checked w/ my representative, & filled out the forms she provided me with, signed, had my employer sign, date the request & turn it in to the agency. I was assured it was taken care of. The next month my employer received a chastising notice from Aflac about being late with the payment - which he did not owe sine the policies were cancelled. The representative claimed they never received a request to cancel. I faxed in the original request & was again assured it would be handled n a timely manner.
The next month, the same thing happened. This time I spoke to a "manager" who was insulting, condescending and just plain rude. She advised me that a "proper signed request" was never received, even though I had a copy of it in my hand. I faxed it over yet again and filed a complaint w/ the Better Business Bureau. A couple of weeks later I received a call from the manager stating both policies were cancelled. I received a letter stating both policies were cancelled & how sorry they were about the way I had been treated.
The next week I received an unsigned letter from the "client services department" threatening me, my coworkers, & my employer with "unfortunate IRS tax situations" if I try to cancel my policy again - they have decided it was in my best interest to "reinstate" my policy?!?! What do you have to do to get a policy cancelled? This is ridiculous! I have properly filled out & signed every single form they have given me. I & my employer have repeatedly requested a cancellation and they reply to these requests with threats of financial ruin?!?!
COLUMBIA, SOUTH CAROLINA -- In November 2011 I signed up for the Aflac critical illness and hospital indemnity plans after hearing their spill during my company insurance sign up. At the time I was seeing a cancer doctor for MDS [a form of bone marrow cancer] and informed the sales reps of it and was told if I signed up during the registration Aflac was waiving all pre-existing conditions but if I did had a pre-existing condition I would need to wait 6 months before filing a claim.
In January I was diagnosed with MDS and filed a claim in May 2012. My claim was denied because Aflac stated there was no evidence to support my condition as being malignant. I appealed and was denied a 2nd time because of it being a pre-existing condition because I was being seen by a doctor at the time I signed up. I contacted my company representative for Aflac back in November 2012 and was told I was misinformed but to send her the paperwork and she'd try to push my 2nd appeal through.
As of March 18th nothing has been done, so on the 24th I filed complaints with the BBB, Idaho Department of Insurance, Idaho Attorney General, and my company HR department. I also sent my complaint to a local TV investigative team. I am telling others about this because I believe a company should stand behind their what they say and Aflac isn't. I have even sent Aflac 2 letters from individuals present in the meeting that heard the sales reps tell me Aflac would waive any pre-existing conditions.