Aflac

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Duck DooDoo
Posted by on
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.
     
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trp2hevn on 2011-04-12:
I would think that it would be the health insurance that would cover the tests and x-rays, not an AFLAC plan. I think it depends on what kind of policy you have too. Now if you have a hospital plan and were admitted to the hospital then you may have gotten some benefit from them (depending on how long you were there). If you have a short-term disability plan, that would probably take like a week of being out of work for whatever ailment. Sounds to me like you misunderstood what the whole purpose of AFLAC is or you don't understand your policy. AFLAC is not health insurance.
Sophia Marie on 2011-04-12:
Aflac is not medical insurance - it is supplemental insurance to help pay for living expenses should the policy holder be deemed unable to work.
momsey on 2011-04-12:
Do you have health insurance? Did you research Aflac before you signed up to see what they would cover? As the others have said, Aflac is not a health insurance, so I'm not surprised that they are not acting as one.
Skye on 2011-04-13:
What does your AFLAC policy say about what and what it will not cover? I thought AFLAC is for when you are cannot work on a temporary basis, due to health issues, and they will pay a percentage to you, until you get back on your feet.
Anonymous on 2011-04-13:
I'm sorry for what are you going through but how are they going to pay you for those tests when the policy does not have benefits for those. They review claims based on the documentation received not the charges. If it is not covered then it is not covered. Please read your policy. It outlines what is covered. And there is no fine print in the polices but there is big bold print but post people don't take the time to read it.
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How to get your AFLAC Claims paid
Posted by on
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 Hosptial 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 HealthInsurance 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.
     
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trp2hevn on 2011-01-10:
Thanks for the tips!
carol on 2014-02-18:
Thank you! This was so helpful.
Scott on 2014-08-19:
I have had policies w/Aflac since 2001. Accident/Short term disability/specified event/and,Dental.In 2011 I had shoulder surgery from a fall at work. The accident policy paid,but the short term did not.Been through 3 different representatives now,and they all tell me I should have had wage compensation , plus PT visits paid for.WRONG ! ! ! Aflac paid 25 bucks on that policy...then stated that I am not covered on the job ! My whole work crew has been told for years now,on the job or off , it does not matter.I raised my case w/state insurance commision,and low and behold , what happened next??? My agent lied to them...put false words in my mouth , and the commission took their words for it and told me that was all they could do for me.( I can not wait to join a class action lawsuit against this Monstrous company).
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Aflac Fraud
Posted by on
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--

ARTHURPERC at aol.com
     
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Anonymous on 2008-05-23:
First, my sincere condolences. The last thing cancer patients need is added worry whether their care is going to be covered by insurance they were 'told' would pay. The poster is 100% correct as to the fate of multi-page claim substantiation forms...they get (appropriately) shoved aside until time permits the Doc to fill out everything that was filled out on the HCFA-1500 (claim form). The insurance companies know this, and thereby slow up paying claims. Why? Because the longer a claim is unpaid, the longer the funds are held (earning interest) by the insurance company. Thank you, Art, for telling your story. Again, my deepest sympathy for your loss.
furnitureman on 2008-05-23:
Sorry to hear that. I have Aflac and my 3 year old had a brain tumor. They paid in a week on each claim I sent in. I never had any problems. Sorry to hear for your loss.
Anonymous on 2008-05-24:
Thank you, Art, (BOOTER) for visiting my page at my3cents. I welcome you to our little online community. My role here is identical to other folks here. We simply interact (and frequently disagree) about consumer issues. My 'mission'? I deplore health insurance companies and government administrated health programs. It is far past time that we allow patients and physicians to interact one-on-one, without having government or a money-grubbing insurance company in the exam room with us. I am deeply (truly!) saddened by stories like yours. From first-hand experience, I know that your wife's doctors were equally devastated by her death. The injury was compounded by a greedy insurance company seeking to hold benefit money a few days more...simply to gain more investment value. Please stick around this site. You have much to offer to others in similar circumstances. Once again, my most sincere condolences for your loss. I have no way to understand how painful the loss of your wife has been.
gladgrad on 2008-06-18:
I too am very sorry for your loss.
Aflac is not primary health insurance, so if you were expecting 3-5 thousand dollars per chemo treatment, from Aflac.. that is not what Aflac does. That is the job of your primary medical insurance which you must have in order to even get an Aflac policy. What Aflac does is pay you cash so you can meet out of pocket expenses; I.e. co-pays and deductables, buy groceries, pay the PG&E or put it toward your rent or mortgage payments, however you see fit. If your agent couldn't help streamline the claim process for you, making it as easy as possible, I apologize... Did you ask your agent for assistance? You could even make copies of a frequently made claim...done correctly and used photo copies only adding any needed info to differenciate each claim..
I've heard stories of people who's houses have been saved due to money they got from Aflac when they were injured.

Aflac is a great company with an excellent reputation. When a company has literally millions of policy holders you are going to find a few who are less than satisfied.

If you have Aflac and need help with a claim go to your agent, if you agent is unable to assist you ask for their DSC and or RSC.

Hope that helps..

TJ
gladgrad on 2008-06-18:
To Ghost of doc J

My mother got lung cancer and was killed by the chemotherapy. Her doctor insisted she was strong enough, I disagreed. 10 days after her first round of chemo she died. Not from the cancer, but from the Chemo treatment. When my sister and I tried to contact him, our many phone calls went unanswered... we never did speak with him, that was 4 years ago. I don't think he was all that broken up by her death.. You cannot lump all doctors into the caring compassionate box nor can you lump all insurance companies in the category of money grubbing crimminals. If you sent a blood sample to the lab and it is mismarked...will you receive the results? No. If you make an insurance claim and leave out necessary information..will you get your money immediately...No.

thank you
Principissa on 2008-06-18:
I am so sorry for your loss. I have lost my grandmother to breast cancer and my aunt Mary to lung cancer.
We have Aflac through my husbands job. The two times we have had to use it due to work related injuries we've not had a problem. If you had the coverage as stated in your policy then they should have paid. You are absolutely right, it should not have taken as long as it did. The last thing that you and especially your wife needed was to be worrying about a claim that should be getting paid while receiving/dealing with a loved one undergoing chemotherapy. Stories like your wifes really break my heart. It shows me that the only thing the doctors and insurance companies care about is money. Not patient care and satisfaction. I am terribly sorry for your loss. Blessed be.
spitfire123 on 2008-07-09:
I am sorry you had this experience. Aflac is not intended to pay for your wife's chemo treatments....that is what health insurance is for. Rather it is supplemental insurance, to help you with bill, and other out of pocket expenses. You had an agent who originally signed you up; why didn't you contact that person and let them handle the claim? I have been an Aflac rep for 12 hears and I alway file all Cancer Claims myself. You could have also called the Regions or State Coordinator where you live (Aflac has many offices in all fifty states.) and they would have been glad to help you out. Aflac is a good company and I have many clients who would have lost their homes if it were for programs like the Cancer Plan. Your experience is not typical.
Oklahoma5 on 2008-11-03:
Sorry for your loss. The claims should not have been so difficult to do, that is why you have an agent.

AFLAC WORKS!!!

Grtcvg4u on 2008-12-02:
My Father-in-Law, was diagnosed with Stage 4 Renal Cell Carcinoma in 2006. Although treated in a military hospital which normally no charge is incurred by the patient, he paid a $9.00 co-pay and with minimal documentation (pathology report, and 2 page claim form) he received his first check for nearly $10,000.00 for removal of his cancerous kidney and 2 day stay in ICU within a week of filing the claim. His cancer spread to his bones and eroded his hip socket causing the need for a hip replacement with a specialist out of town. Aflac paid for the ambulance ride, my Mother-in-Laws mileage, benefit for hotel stay and the surgery itself. He is now on oral chemotherapy medication and receiving $300.00 per month from Aflac for the last 2 and a half years. Running total is over $23,000 so far and they still collect the annual wellness benefits too. My Step Father used it for his prostate Cancer and my Mother uses the plan for her skin cancer removals. They are always paid promptly.
abbie6 on 2009-02-15:
YOU SHOULD GO DIRECTLY THROUGH YOUR AGENT TO FILE A CLAIM. THIS CLAIM WOULD HAVE BEEN PAID RIGHT AWAY AND YOU WOULD NOT HAVE HAD THE ISSUES YOU HAD. AN AGENT MAKES ALL THE DIFFERENCE. IF THEY DIDN'T PROMPTLY RETURN YOUR CALL OR HELP YOU YOU SHOULD HAVE CALLED YOUR STATE AFLAC OFFICE AND FILED A COMPLAINT AND SOMEONE WOULD HAVE GOTTEN BACK WITH YOU RIGHT AWAY AND ADDRESSSED THE PROBLEM!!!!!! AFLAC IS GREAT AND PAYS THOUSANDS TO CANCER PATIENTS-BUT JUST LIKE ANY INSURANCE COMPANY, IF YOU DON'T' HAVE A GOOD AGENT IT CAN MAKE YOUR EXPERIENCE BAD.
timjdd on 2009-06-15:
Actually, Aflac does not coordinate benefits with other insurance companies, and a claimant does not have to wait until the primary insurance has paid anything (that very often takes several weeks if not months!) to the care provider. Aflac pays directly to the claimant, regardless of other insurance. A reputable agent will not sell supplemental policies to employees who have no primary insurance without fully explaining the concept of "supplemental" and giving the employee a reasonable expectation of potential costs of treatments compared to what benefits Aflac will probably pay. As a reputable agent myself, a potential client will have to practically order me to sell them a policy in that situation (if their employer is making it available, I have no right to deny them the application process, but at least I have a clear conscience if I have tried to talk them out of it first,using logic, and I usually try to talk them into a Disability policy instead, which covers more possible situations than just getting cancer).
The Fork on 2010-08-10:
I've never had a single problem with any of my 4 Aflac policies. They pay quickly--usually within 3 or 4 days and have saved our home and possessions on more than one occasion. Sorry to hear about your difficulties.
Jackie on 2011-11-22:
It saddens me to hear that agents have not represented this company well and have not taken care of their claiments in a time of extreme need. I have worked in the admin department for 4 years now and absolutely love the tears of joy that stream down my clients face when I assure them that not only will everything be OK, but that I will help them do my best to make sure the claim process goes smoothly as possible. After working in my position, it is never about the commission but seeing a weight lifted off of someone's shoulder when you can happily say "you have thousands of dollars coming to you. Really. It was just mailed yesterday and is on its way!" I believe you did not have a experienced agent for this detrimental of a claim. I highly suggest contacting a different local office in your area and findind someone like me (because we are out there!) who will assist you through every step and even do most footwork for you.
I have found that many policyholders will get frustrated because they do not understand because that their agent hasn't taken the time to explain anything!
In no way am I responding to this blog to defend my company. I am simply responding to apologize for someone else's ignorance and immaturity who did not give you the service you so very much are due respect for. I have delt with a dozen people who have lost their spouses and even children and I have been able to help them through this process with nothing but a smile on their face.
I am very sorry about your loss. Since it has been some time and maybe your frustration has somewhat subsided, I very highly suggest trying our claims process just one more time with an experience agent or administrator. We will never deny a claim because it happened "too long ago."
Again, my apologies for difficulties. No one deserves it.
I hope you have found peace.

- District Administrator in California
hd on 2012-03-18:
So far I've noticed its only the agents who seem happy with aflec - thank you for your review. I had allstate for an auto accident and it was exactly the same thing.
halco12 on 2012-05-27:
If AFLAC is so good, why do they terminate 1000's of agents every year?
jbs2065 on 2013-05-08:
Wife diagnosed with stage2 breast cancer. Filed the claim, 5 days later had a check for $21k, no issues. She's still dealing with various chemo and radiation therapy after her surgery, and we've learned that there is likely a benefit for each of the 52 Herceptin treatments she will have to receive. Sorry your experience with them wasn't positive but I believe you are in a small minority.
Bill on 2013-06-06:
I know this is and old post but will relate my experience with AFLAC too. First if you have a claim-- avoid using the corporate claim process entirely or you will go through the headaches described above-- instead have the local agent (the one that sold you the policy) handle the claims-- Doing this is the most painless way to get your claims paid in a timely manner (at least with my local agent)

The doctor's should have very little to do regarding proof of claims-- everything should be in your medical file and the hospital/cancer treatment center should have staff members that can get copies of whatever you need.

What you need to get started--

Statement of diagnosis for cancer from physician (for tumors-- you will need pathology report)-- not sure how luekemia is handled??

Treatment plan-- this will indicate the course of treatment (drugs and their periodicity).

The above will get you started and will get you your initial diagnosis (First occurrence benefit).

For followup claims-- find the phone number for whoever handles billing-- each month you will need to make a phone call around the 15th of the month-- ask for "itemized billing statements for the previous month"-- this will list ALL charges for drugs administered-- you want to wait a few weeks after the end of the month for the claims to be processed-- while the primary insurance claims may still be pending, the charges should all be listed...

When you get these-- make a copy of them-- go through and highlight every payable claim for chemo therapy-- the drugs should be listed with their administer date and should match up with your treatment plan.

If you have the ability-- scan them and email them to your local agent and I always will give them a summary of what should be paid for that month-- if you can't scan them I would mail or hand deliver them....

let the agent handle the claim-- within a week or two you should get a check-- look over the EOB (explanation of benefits) with the check and make sure they didn't miss anything...if so, call your agent immediately.

Staple the EOB to your copy of the itemized billing statement and file it away.

I urge whoever does this to do it monthly-- it is harder to keep track of several months of treatments and you don't want to inundate the agent either.

If you have surgery-- GET THE SURGICAL REPORT from the surgeon's office and submit this with your itemized billing statement for the surgical procedure.

My 7 year old son has been battling Cancer for 3 years-- 1 year initial treatment, 1 year of remission, 1 year since his relapse--- AFLAC insurance is not designed to be a primary payor-- it is designed to pay you back for missed work, co-pays, incidentals-- I have excellent primary insurance and my employer has been very supportive (paid time off vs unpaid)-- as a result of this AFLAC has allowed my wife to not have to work and helped pay for allowing us to spoil my son (trips, toys, vacations)

Hope this helps someone out there.
michael on 2013-07-24:
sorry for your loss, I've had Aflac for a while and have had several accidents,they sent me at least some money within the first week until all the forms were received, I have had super luck with them. Try dealing with Colonial Life now they are a headache
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Threats of "unfortunate IRS tax situation" to me & my employer if I cancel
Posted by on
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 chastizing notice from Aflac about being late with the payment-wh he did not owe sine the polocies were cancelled. The representative claimed they never received a requrst 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 H my employer have repeatedly requested a cancellation and they reply to these requests with threats of financial ruin?!?!
     
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trmn8r on 2011-06-12:
This sounds like it is related to a certain rate being negotiated between your company and the insurer based on participation, and the insurer isn't happy that you cancelled.

What has your HR rep advised you about this? Good luck!
MDSasquatch on 2011-06-12:
My brother has AFLAC, he was in a work related accident and was off work for two weeks. AFLAC pays for his "hospital time" his time at home was not covered. He got < $100 for two weeks of disability. He too cancelled his policy. In his words "AFLAC Sucks"
madconsumer on 2011-06-12:
was the policy under a term agreement?
HelpfulAgent on 2012-12-05:
It sounds like to me, your company had a Cafeteria Plan with Aflac and your premiums were deducted Pre-Tax from your payroll. If this is the case, you are bound by the Plan Year of your company's agreement. You are only allowed to make cancellations during Open Enrollment, once per year. The only time you can make changes during the plan year is if there is a marrial status change, birth/adoption of a child. If the company had a Cafeteria Flex Plan in place and the deductions for your hospital and accident plan were deducted "Pre-Tax", and you cancelled mid-plan year, this is where the IRS can be a problem.

Since all Aflac Associate Agents are Independent Agents, unfortunately, there are those agents that just get the account and then never follow-up or service the account. On the other hand, there are many of us who take very good care of our accounts/policyholders. If there is a question/problem, we do our best to assist the policyholder.

If you ever have any question/problem, and your Agent is not available or was unable to rectify your problem, ALWAYS call Aflac Headquarters, give them your policy number and have them explain the policy's benefits, exceptions, Cafeteria Plan year, if any. ALWAYS get the person's name you are talking to and a Call Reference Number so if there is a problem, the call can be referred back to.

Aflac is a great company and has the best supplemental products in the market. I hope you will give Aflac another try.
dave on 2013-09-02:
I was looking into getting a policy but not after reading these reviews. Other websites have similar complaints
Lee on 2013-09-12:
I was told the same thing by my company's AFLAC rep that if I try to cancel my pre-tax STD policy that the company could be fined $1000s of dollars by the IRS if audited. ITS BS!!! I called the IRS and spoke to tax and law regulation dept about cafeteria 125 plans and the rules. This guy said its a scare tactic! Its at the discretion of the employer to cancel your plan. The only way you can't cancel is if its your company's policy. The IRS has nothing to do with STD polices. There is NO RED FLAG that shows up if they cancel it. He told me there is no way they can know when open enrollment is, how much you pay, or if you cancel it. The only product that might cause an audit is a 401k plan. CALL THE IRS!!!
Jack on 2013-10-07:
I have been through this. The IRS can, and will, fine up to 1k a day, per employee, per day, that you are out of compliance. Out of compliance is having pre-taxed policies dropped without a legitimate change of status. STD policies are usually paid for with after tax dollars, so, no, they wouldn't normally be an issue. Everyone wants to blame an agent or the company for their own ignorance of what they have. I found out the hard way. It is at the employers discretion to allow a person to drop their coverage, but it has its risks. I still allow my employees the opportunity to get and keep Aflac. Many have benefitted tremendously from their policies. Now, if someone wants to drop mid-plan year, I make them a part time employee until the change is in writing. They don't like the drop in hours, but it saves me a possible fine and they learn the value of sticking to an agreement. Sounds harsh, I know, but I am in business to make a profit so I can actually pay my employees, not pay fines.
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Another Aflac Deception
Posted by on
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 disablity 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 someones 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 there 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 its to 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.
     
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Anonymous on 2010-10-30:
I'm sorry to hear of your wife's illness. It pays to ask questions and get clarification on policies, I learned that the hard way too.
Anonymous on 2010-10-30:
It is misleading and deceptive. Have you filed a complaint with the Insurance Commission for your state? If not, you should consider doing so. I am glad your wife is on the road to recovery.
oars81 on 2010-11-15:
I'm sorry to hear of your complications with Aflac. I have nothing but good to say about Aflac. I was looking into getting disability insurance for my wife through my Aflac DI policy. In my state I know that the spouse di rider only covers up to 700 dollars in monthly benefit. and that was for accident only. I hope that your rep explained that to you at the time. If not then the rep did not do his/her job, and in that case that sucks.
Steve1977 on 2010-12-01:
I'm sorry to hear about what you went through. However, Aflac did not fail to come through. Their policies specifically state what they cover. Your base accident policy may be husband/spouse coverage which is for the actual treatment of the injury but in order for your wife to have disability coverage then she would have needed her on disability policy or you would have to have a spousal disability rider. It's always best to read your policy when you first get it and call customer service if you don't understand. People often don't take the time to understand their coverage and they are mad at the company when something is not covered. And the person who is saying that it is misleading does not know what they are talking about.
Bill 1967 on 2011-07-07:
Hey, I'm also sorry to hear about your wife. I lost mine a few months ago and she was only 44.
As to your "complaint" regarding AFLAC. I can personally tell you ( and yes I'm an agent" ) that AFLAC payes out huge amounts to the client....when you have money coming under your policy. I got started in AFLAC when they paid me $22,500.00 for my sons accident. I also know first hand of benefit pay outs when they did not have to !....I'm thinking of a claim for over $148,000.00 paid out on a cancer policy where a waiting period was not reached , Bottom line...AFLAC is a great company and they really do try to do the right thing. My best advise is
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Aflac Circle Jerk!
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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 of 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 shear 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!
     
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lessthanzero on 2009-06-14:
Thank you for this informative post. I have read that Aflac tends to do what they did to you as a "normal business practice". This is an outrage, especially in light of their advertising, maybe you could file a complaint for false advertising. I would recommend that you file a complaint with your States Department of Insurance (regulation). Good luck.
wijeke on 2009-06-23:
what elimination period did you have?

The elimination period is as follows in NC the first number being for accident and the second being for sickness.

Elimination Periods (Accident/Sickness): 0/7, 0/14, 7/14,
0/30, 30/30, 60/60, 90/90, 180/180

Was your surgery for an injury or because you had ongoing pain from arthritis or something. Depending on these factors would make the difference of when you start qualifying for benefits.

I am sorry for this happening to you, but I didn't see in the story where you said the need for the surgery and your elimination periods.
Librals on 2009-06-23:
My insurance required me to have a two week "waiting period" for benefits to commence. I JUST received my check yesterday as a matter of fact. The first week that I was entitled a check, I received the first day I went back to work after being out for five weeks. I just received the check for the remaining two weeks after I had been back to work, that's right - BACK TO WORK - for 23 days!!!! Big help that disability check was! My surgery was due to an arthritic wrist joint from what they believe to have been a possible fracture at some point. The arthritis had basically frozen my wrist, limiting my ROM and causing me great pain. I have to say that I am now pain free and am thrilled, regardless of the pain Aflac inflicted upon me; that I had the surgery performed.
Kallen1952 on 2009-06-24:
You say you had surgery 5/23/09 and you wrote your first complaint letter on June 14, 2009 and by then you had been back at work two weeks? Either your dates are off or you were only off work about a week.
Aflac has been great to me. When I had shoulder surgery I filed for State Disability and also Aflac Disability. My doctor said I'd be off 3 months and State Disability said my SSN had been used on another claim a year prior and there would be a delay while they investigated. Aflac paid me for the entire 3 months UP FRONT. If it weren't for Aflac, I would have been screwed with no income at all.
Librals on 2009-06-24:
I apologize, my surgery date was in fact 4/23/09. I'm happy to hear that Aflac did what you paid them to do. Your last line stated that you "would have been screwed with no income at all," this is exactly what happened to me. I received not a single check from them until AFTER I had returned to work. It was beyond stressful and traumatic while attempting to heal from major surgery, there was no peace of mind. I am thrilled for you that you did not have the same horrific experience that I did. I do understand that not all claims placed to Aflac are overlooked and mismanaged as mine had been.
Kallen1952 on 2009-06-25:
Librals...The claim I filed that went well was years ago. I have just filed a new claim for my husband for accident and hospitalization benefits and I'll report later how that goes. I have to admit I'm nervous. I've been paying them a lot of money every money for years, they better pay up when I file a legitimate claim.
Librals on 2009-06-27:
Kallen1952 - I do wish you luck with your husband's claim, as well as for his speedy recovery. I am hoping that my situation is only an isolated one. Please let me know how you make out, good luck! Lori
frank90210 on 2010-02-14:
A few years ago I was only 16 working at the grocery store. My mother had the Aflac accident policy. She got into a car crash, head on at that. She was going 40 mph, the truck coming at her was going 40 mph. she had no air bags, the steering wheel had the plastic cover removed before this crash, instead it was pure metal. Her face smacked that metal at 80 mph. she shattered every bone in her face from her forehead, nose, eye sockets, cheekbones, jaw, and all her teeth... shattered like glass or crushed like an egg shell, however you want to word it. On top of that she broke one arm and one leg. It was 40 degrees below zero and the ambulance took 45 minutes to get to her, she should have been killed, the doctors didn’t know how the hell she made it. Anyway, her Aflac agent sold her this policy through the union, so the money for it came out of her paycheck directly to her union, her union then pays Aflac... well her union decided to embezzle all her payments as well as several others payments (the union was stealing all these monthly payments / premiums) so when she called up Aflac and told them what happened, Aflac told her they had her name on file but received no $$ from her.. Well Aflac had her send in the 5 months of payments they should have gotten and sent her a check for a little over $5,000. At this point no one knew why Aflac never got her payments; it was 6 months later it was discovered the union was stealing. Anyway she was out of work for 9 months recovering; Aflac was sending her checks for 5,000 to 7,000 each month... Aflac was the only reason we still had a roof over our heads, food on the table, and clean water. ... So a few years later here I am, an agent for Aflac. The guy who started this thread posting about how Aflac is a scam... well here’s some info about Aflac. Aflac is a FORTUNE 500 COMPANY, currently 186 on the list, Aflac has an A+ Superior from AM Best, Aflac has been named to fortune magazines list of Americas most Admired Companies for the past 8 consecutive years... by the way, there is no competitor who comes half way close to this. Whether its state farm, colonial, or Allstate... I am not saying anything bad about them, but they do not rank anywhere near Aflac. First of all, out claims processing happens at our worldwide headquarters, most claims take just 4 days, the agents of course will help you do the claims, and we make sure to explain that, also he had an experienced agent if he is correct about 450 people from his work decided not to go with Aflac, only experienced agents go to bigger companies. New agents aren’t allowed to go to big companies like that; new agents stick to 5-20 man companies preferably privately owned... I don't know what his deal is, but after reading his post, I'm positive he is full of it. He is possibly a competitor who has it rough because everywhere he goes, they all have Aflac. I am friends with a few people who work for competitor supplemental insurance companies such as the ones I listed above, and everywhere they go, they have Aflac so my friends are S.O.L and 2 of my friends I am now working with here at Aflac, the #1 supplemental insurance company in the world. Short story short, the guy who posted this story is lying. I know too much about how Aflac works. The only way that Aflac would take a long time like that is if he had been convicted of felonies, and Aflac suspected suspicious activity, and even then it would not have taken half as long. Do not believe every single “This Company is bad” story you hear.
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StarEmpty StarEmpty StarEmpty StarEmpty Star
Company Stole Over $500.00 and Refused to Provide Me Services. They Terminated My Policy and Left Me With Out Maternity Coverage
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Rating: 1/51
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 REF # Q01WC82 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 Ref# Q01WDY5, 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. [snip]Coler REF# O010B0C 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 [snip]Bergman, 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 as 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
     
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Soaring Consumer on 2013-06-27:
I suggest filing a complaint here:
http://www.oci.ga.gov/
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StarEmpty StarEmpty StarEmpty StarEmpty Star
It's a Hassle to Cancel and Easy to Join. They Make It Easy to Get Your Money and Harder to Get It Back.
Posted by on
Rating: 1/51
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 employees over 300 people, that let them come in monthly and offer their services, to not receive anymore services from this company because of the termoil they will take you through. It is cheaper and the customer service is better with a real insurance company and less of a hassle!
     
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jonthethird on 2012-09-30:
Most such agencies want something in writing to protect themselves. What would happen if they cancelled your insurance in error, stopped taking the money out, and then you filed a claim thinking you were still insured?
CowboyFan on 2012-10-01:
Like most people, the OP thinks that they can simply call up and that resolves the matter. A prudent person would always follow up on such a matter with a letter, sent certified/return receipt, so that there would be evidence they cancelled. This protects both the consumer and the company.

It is the failure to follow up in writing that caused the problem, not the company's policy. That one called on the telephone constitutes "no" proof that one cancelled it, or did whatever else one wants to do. Written letters on major matters is the best advice in any such situation.
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Ripoff
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I have two policies with Aflac... short term disablity and accident. After paying thousands of dollars over the years to Aflac I finally needed them this year when I hurt myself and had to have surgery for a hernia. I was off work for over a month and after many denials of my claims and several months, all I received was approx: 700 dollars.

My accident policy alone lists my hernia surgery as a 1200 dollar payout. I was so angry I called Aflac to cancel my insurance with them and was told that I couldn't cancel til the next open date which will be sometime in November... what's worse is she also said they would continue billing me right on through to next year and there was nothing I could do about it... I HATE AFlac!!!!!
     
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Kris10 on 2011-09-14:
Bring this up with your State's Insurance Commission or similar. That isn't right and there are laws that protect you as the consumer.

I hope you feel better soon!
Melin on 2012-01-26:
Aflac likes to collect to keep there duck on TV. When it comes time to pay they are all about denials!
Melin on 2012-01-26:
Kris10 sorry but the Insuarance commission is overworked and it may take a year or more for them to review!
Jatisna09 on 2012-09-26:
I agree Aflac isn't that helpful and on my case whe I gave birth they denied my insurance claim and I'm still working in getting my premiums back. It's been 5 months now. I wish that someone would sue this company.
John on 2013-06-28:
Paid these people for Short Term Disability for 5 years, Wife has Accident on me for same amount of time. Hernia surgery is an "Illness" not, "Ingurey" to these morans therefore claim DENIED!!! Off work 7 days and am now trying to figure out how to make the mortgage payment with them still taking MY MONEY every WEEK. Go to hell AFLAC!
Lynn on 2014-06-05:
From what I've read thus far about Aflac not paying claims, and they couldn't cancel their policy seems simple to me. Firstly, if you don't submit supporting documentation "read your policy" of course your claim can't be paid. Then the mention of not being able to cancel until a "specific date" means you purchased your policy on a pre-tax basis and its a IRS regulation that you can only cancel during open enrollment. Now, before you smear a company why don't you read your policy and education yourself prior to purchasing supplemental (meaning its not major medical coverage) coverage. Knowledge is powerful!"
Lynn on 2014-06-05:
With all do respect, the accident policy covers "accidents only" if you didn't provide the details of the accident that caused your hernia- why would you expect to get paid? Do yourself a favor and actually read YOUR policy...after all, you did sign the application and had your read the policy, decided its not for you...it clearly states you have 30 days to return it w/a refund.
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Uninformed Agents
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I have had an AFLAC Accident policy with a sickness rider since 1998, and except for the $60.00 per year for my physical I have never made a claim on it. That was, until now. I had surgery in August, and then again in December. I was told by the agent that sold me the policy that they wouldn't cover my claim because I'm a teacher, and I had the procedure during the summer. Then the reps came to school during open enrollment period and I explained my situation, plus the fact that I'd be having surgery again in a month. They "called the company," who said that I'd be covered for both, and told me they'd e-mail me the proper form. It was not the correct form, after I had the doctor fill it out (x2).

I called the customer service number and they told me what form I needed. I had to go back to the doctor and have them fill the new ones out. I called the representative and told him that I had had enough of AFLAC and I wanted to cancel it (I've certainly paid enough over the years) and he sent me a cancellation form. I called customer service just to be sure that was the right paperwork this time, and they told me my company would suffer tax consequences if I cancelled now. He never told me that.

While I realize this may sound confusing to read, it has been even more confusing to experience! One mess-up after another. The message on the customer service line tells you to go to AFLACNY.com for online information. There is no AFLACNY.com.... you go to the main site. The rep's name on my page when I finally do get logged on is incorrect.

The errors just go on and on. I'm sorry, but come November, I'm finished with AFLAC. I'm lucky I have patient office staff at the doctor's office!!!
     
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Alain on 2011-02-13:
This does sound like you received poor service. You might want to inquire with your state's insurance commission to file a complaint.
Anonymous on 2011-04-13:
I'm sorry of what you are going through. There really isn't enough info here to contact. As far as the agent's calling the company and they said both was covered, Aflac CSR's can never guarantee benefits over the phone. They can only tell you what the policy says and tell you what to submit. No policy covers everything and your policy tells you the limitations and exclusions. I understand some of this is hard to understand at first. I don't know the specifics of your situation so I am not going to assume anything there.
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