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.
BAKERSFIELD, CALIFORNIA -- In 2012 I had worked for a school district and when I left I took my Aflac policies with me. Most of you know as you get older your balance is not as good as it used to be. I had fallen because of my dogs and had multiple injuries. Aflac paid at first, after recovering from that incident I was injured again when a horse stepped on my foot and broke it. From that point on they were harder to deal with. Every fax sent in ended up getting misplaced.
My last claim was lost multiple times. When I called about it the next thing I knew I was getting letters asking for office notes from the doctor's office, letterhead from the company I work for and copies of my paychecks proving my income. Basically I was made to feel like I was being called a liar. I sent in everything asked for.
Finally I gave up and it has been a hardship. I have heard more complaints than I have good about Aflac and I feel that by responding with such a positive attitude at the very beginning I may have led some people into purchasing a policy. I apologize for that, I do know that Aflac monitors this site and responds on it frequently. So again I was wrong and so many others were right.
ARIZONA -- Denying hospital indemnity. According to policy, a 23-hour minimum stay is required (admitted to hospital). The UB04 I submitted clearly is for over 23 hours, yet they are denying claim based on number of hours of observed care my husband had, which was 19 hours. Where in our policy does it say anything about observed hours... nowhere! Lying, cheating, incompetent, waste of money and my time trying to get these morons to pay up. They misdirected the claim to cancer... not our mistake... theirs, I've re-filed this claim 5 times. I've been lied to at least 3 times. Would love to kick that duck in the butt so hard that my foot comes out of his beak!
SAGINAW, MICHIGAN -- Hearing lots of complaints about AFLAC but they all seem to be about the short term disability coverage. I had no issues with the STD coverage attached to my Accident policy. In fact, didn't even know I had coverage. AFLAC's best feature is their Sickness & Hospital Indemnity policies as I have both. Have made tons of $$$ having this policy, paying for Dr visits, MRIs, CTs, EEGs, EDGs, colonoscopies, pain clinic procedures, surgeries, etc...
They also let you claim back years. Now I'm claiming up to 6 years back, things I didn't even know I could get money for. You just call AFLAC and they spend as much time as needed telling you all the benefits or each policy and each year that you haven't claimed. Loving Aflac these days! These policies also pay well if you have to be in the hospital or undergo anesthesia.
EL DORADO HILLS, CALIFORNIA -- Every week, sometimes twice a week, another new face representing Aflac comes to waste our time trying to sell us door to door insurance. Each time we ask them not to return. They keep coming, a new person, normally 2, each time. I hate this company now, and by proxy, the people representing them. Each time I get more irritated, and next time I just might put the next solicitor's head through the glass door. If you work for Aflac selling insurance of all things door to door, you should really take a look at your life and be sad about the events that led you to work for Aflac. 1 star and I'm not a customer, nor will I ever be a customer now.
HOUGHTON, MICHIGAN -- No need to get into a long story. The bottom line is, I was lied to and given false information just so they could take my money for 10 years. Now, I need my benefits and they refuse to pay what I am entitled to! They should be investigated for what they are doing to people!!
WASHINGTON, DC, DISTRICT OF COLUMBIA -- I'm a member for 4 years and knew I had to get dental work done. My insurance took care of my gum surgery and I was informed by my dentist that AFLAC is a waste of money. He asked me if AFLAC Dental was helpful for me. I told him, "No. In fact, trying to cancel is harder than joining." AFLAC dental is a joke! Who pays for a dentist out of pocket?
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.
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.