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Aflac Fraud
Posted by BOOTER on 05/23/2008
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 wifes 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 of 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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Posted by 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.
Posted by furnitureman on 2008-05-23:
Sorry to hear that. I have Aflac and my 3 year old had a brain tumor. They paid within in a week on each claim I sent in. I never had any problems. Sorry to hear for your loss.
Posted by 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.
Posted by 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..

Posted by 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 catagory of money grubbing crimminals. If you sent a blood sample to the lab and it is mismarked...will you recieve the results? No. If you make an insurance claim and leave out necessary information..will you get your money immediately...No.

thank you
Posted by 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.
Posted by 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.
Posted by 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.


Posted by 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.
Posted by abbie6 on 2009-02-15:
Posted by 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 likely 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).
Posted by 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 posessions on more than one occasion. Sorry to hear about your difficulties.
Posted by 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 due to the fact that their agent hasnt taken the time to explain anything!
In no way am I responding to this blog to defend my company. I am simply responding to apoligize 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
Posted by 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.
Posted by halco12 on 2012-05-27:
If AFLAC is so good, why do they terminate 1000's of agents every year?
Posted by 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.
Posted by 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 occurance 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.
Posted by michael on 2013-07-24:
sorry for your loss, ive had Aflac for awhile and have had several accidents,they sent me at least some money within the first week untill all the forms were recieved, i have had super luck with them. Try dealing with Colonial Life now they are a headache
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Aflac Dental Policy: Not Worth It
Posted by AFLAC Dental: Not worth it on 03/09/2009
MYRTLE BEACH, SOUTH CAROLINA -- I have AFLAC for my dental policy and although they are very easy to file a claim with, what you get back is pennies compared to what you spend. I had 1200 dollars worth of work done on 2 teeth and they only reimbursed me $75.00. Also I think that they way AFLAC works is insane. The fact that you have to pay in full for all your services first and then file a claim with AFLAC is crap. That is not the point of insurance. If I have the money to pay for my services why the hell do I need the insurance?! It just doesn't make sense.

AFLAC needs to redo how they work things. My policy is up in April and I am cancelling immediately.
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Posted by saj80 on 2009-03-09:
Isn't AFLAC just supplemental insurance? If so, then they have set amounts they will reimburse for.
Posted by AFLAC Dental: Not worth it on 2009-03-14:
Yes it is supplemental, however their amounts they reimburse you for are still way too low.
Posted by Nohandle on 2009-03-14:
I don't have AFLAC, but the company I'm with offers it to those employees interested. It is intended as a supplimental, not primary insurance. If anyone feels the amount paid for a claim is not adequate then by all means cancel the coverage. I have a co-worker who was treated for thyroid cancer. Her Blue Cross paid for her surgery and follow up treatments, sick pay took care of her lost wages and AFLAC sent her a check which was far more than the premiums she had paid through the years.

I'm curious AFLAC dental, does AFLAC state the amount they will pay for a given claim in their policy?
Posted by timjdd on 2009-06-15:
Aflac Dental has different levels of coverage, the cheapest of which is intended to be a supplement to other dental insurance (most group plans have very low annual limits on benefits, thus the need for a supplement for some employees who anticipate heavy use of dental insurance). Because Aflac is sold as an individual, not group, policy, there are waiting periods on all but the most basic of benefits (the $75 the rater received was most likely a Wellness or X-ray benefit which is not subject to a waiting period). The policy itself spells out exactly how much it will pay for each American Dental Association (ADA) code that typical dentists use in filing claims with any insurance company. When dental insurance is offered as an individual and not a group policy, the insurance company already knows that only people who intend to use the coverage in the near future will sign up, intending to keep the insurance only so long as they are undergoing treatment. Once treatment ends, many people simply intend to cancel their coverage, meaning that they will have received far more in benefits than they ever paid in premiums. Since this is an obvious losing proposition, Aflac imposes waiting periods for actual dental treatments, and the more extensive and expensive the treatment, the longer the waiting period. I suspect the original rater filed a claim for services performed before the waiting period had expired. A good agent would have explained in detail the concept and need for waiting periods during the sales presentation and before any buying decision had been made (that is, if he or she wanted to actually maintain good client relations--the waiting periods are the most glaring potential minefield for client dissatisfaction).
I have been an Aflac agent for over 12 years, and only a very few of my employer clients use our Dental options. While they understand that their employees want to have a dental option, they are not willing to pay for a group plan, because the vast majority of group plans impose guaranteed levels of employee participation (some as high as 60-70%) which are difficult to achieve with voluntary products, as there are rarely that many employees expecting to need dental work at any one time, and so they don't choose to spend their money in that way.
Posted by HD on 2012-03-18:
Hi, thank you for this review - so far I've found its just easier to pay for the whole thing in cash. Insurance seems a waste of time for sure.
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Posted by Chriscochran40 on 09/14/2011
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 Novemeber... whats 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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Posted by 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!
Posted by 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!
Posted by 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!
Posted by 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.
Posted by 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!
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Aflac Circle Jerk!
Posted by Librals on 06/14/2009
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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Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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
Posted by 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 world wide 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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How to get your AFLAC Claims paid
Posted by Floridagal on 01/10/2011
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 yeild 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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Posted by trp2hevn on 2011-01-10:
Thanks for the tips!
Posted by carol on 2014-02-18:
Thank you! This was so helpful.
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Another Aflac Deception
Posted by Sp0iler on 10/30/2010
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 it's 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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Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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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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 Charlsiepayne on 09/29/2012
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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Posted by 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?
Posted by 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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Threats of "unfortunate IRS tax situation" to me & my employer if I cancel
Posted by Sacmae on 06/12/2011
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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Posted by 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!
Posted by 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"
Posted by madconsumer on 2011-06-12:
was the policy under a term agreement?
Posted by 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.
Posted by dave on 2013-09-02:
I was looking into getting a policy but not after reading these reviews. Other websites have similar complaints
Posted by 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!!!
Posted by 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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Worst Company Ever!
Posted by Karenruth on 08/13/2010

My husband purchased a policy through Aflac due to an upcoming surgery. The agent told him it would cover his disability for the time he was off (6 weeks) His surgery was in November 2009 and as of today August 2010, we have not received anything from Aflac but the runaround. We had received 2 letters (in May 2010 and June 2010) stating they needed records from July 2009. Why? His surgery was in November. We even spoke with a so called Manager and was still not told a reason why they needed those records. So, we went ahead and faxed all requested information in July, I have called 3 times since July and we always get the same answer, "This claim in under review" Come on, like it takes that long to review records. Starting next week, our lawyer will be taking this over.

The customer service reps have no information what so ever, but they are very nice. That is about the only nice thing I can say about this company. The management staff needs a few classes in customer service, and not to mention some information about the company it self, they were very ignorant.

I would NEVER recommend this company to anyone. I will make sure I tell everyone I know what an AWFUL company this is.
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Posted by Weedwhacked on 2010-08-13:
I'm surprised they let you take out a policy knowing about the surgery. They normally hope you don't make a claim. They will probably deny the claim saying it was a "pre-condition."
Posted by Helpful on 2010-08-13:
I was about to say the same thing as WW. Most insurance doesn't allow you to make a claim for a certain length of time just to protect against this scenario.

Get a copy of your policy and read it carefully.
Posted by jen1357 on 2010-09-01:
The reason your claim is not being paid is because you took out the policy because of something that was already planned for your husband. Had you not already known that he would have to have a surgery and something did happen after the policy was purchased that was not already diagnosed or recommended at the time of purchase Aflac would pay the claim. The reason they will not pay on something that is already planned or recommended is because they would have to raise the rates extremely high to cover their losses on every person that decided to purchase a policy only because something already has happened.

Aflac is to protect you on something that may happen not on something that had already happened. Your complaint is like purchasing auto ins. because of an accident that has already happened and expect the ins. company to pay for the damage that happened previously to you purchasing your policy.

If you really did disclose to the Aflac agent that you were purchasing the policy to cover a surgery that you already knew would happen and they advised you that the Short Term Disability would cover your husbands already planned surgery, they were incorrect and I would report them to Aflac immediately.
Posted by oars81 on 2010-11-15:
what you are describing would be the same as crashing your car, then saying crap I should have car insurance. Then going to the closest car insurer and getting car insurance. then once you get the car insurance, you are pissed cause they will not pay for the repairs to your car that happened before they were insuring your car. It is ridiculous to expect an insurance company to pay for that.
It's not AFLACs fault that you didn't get the insurance prior to your condition onset. However if your agent told you that it would be covered, then that is bad business on the agents part, not the companies part.
Posted by Charlie007 on 2011-03-14:
They are requesting records from July to find out if there was anything pre-existing. Read the brochure that the agent gave your husband when he signed up. There you will find the definition of "Pre-Existing Limitations."
ObamaCare won't kick in until 2014 so "pre-existing conditions" are still going to be a huge factor in getting paid by Aflac or any other insurance company.
This definitely sounds like a pre-existing situation.
Posted by Chris on 2012-03-15:
If you all read this post correctly, it stated that " The agent told us it would cover his disability." This company is a complete fraud
Posted by Jack on 2014-04-03:
1. Obamacare has no effect on supplemental products. Companies offering supplements can have pre-existing condition clauses.
2. If the agent told you the disability would be covered, they lied. The policy, which most people tend to NEVER read, tells you everything you need to know.
3. Yes, I am a broker and Aflac is my #1 supplement I sell. I am contracted with others, but they just don't compare to Aflac.
4. There ARE people in the world that will try to rip you off. Aflac agents are self- employed. I have, and probably will again, refuse to work with agents who I believe are unscrupulous.
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Better to Aflac policies
Posted by Nancy-nurse on 04/14/2011
There seems to be two problems I have found with Aflac. 1. They seem to roll through a number of agents. 2. Their claims services seems designed to wear down the claimant. I believe company greed causes both of these observed problems to occur. Without the agent who sold you the policy actively engaged, you have no local service representative. You will find you are on your own when the event you bought the insurance arises. I was asked to have Doctors fill out forms and re-file and explain details and get additional information on three separate occasions with weeks going by between company requests. Their claims service as well as their company goal is to not aid in paying claims. They spend an inordinate amount of money advertising when compared to other similar companies and I expect them to continue do so, but not with my money.
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Posted by leet60 on 2011-04-14:
You hit two points right on the money:

"Their claims services seems designed to wear down the claimant."

"Their claims service as well as their company goal is to not aid in paying claims. "

Despite what any insurance agent will tell you when trying to sell you a policy, the company is in business to make a profit. Claims representatives receive training from most companies in how to find criteria to deny a claim, making it as difficult as possible for the insured to receive benefits.

This is not only Aflac, but most insurers.
Posted by Anonymous on 2011-04-17:
I'm sorry but it sounds like you did not send in the information needed. What information are they asking for? They can request the information needed from the doctor but they need an authorization form due to Federal privacy regulations. Leet60 does not know what he or she is talking about. Were you there for there training? No you were not, but I was. They are instructed to find every reason to pay. I am no longer there due to moving out of town but I've noticed something about customers in every industry. There are going to be those that have to complain when it they have no valid complaint.
Posted by leet60 on 2011-04-19:
@sjacobs3377. You are correct, I was not there with AFLAC for the training. I worked for other insurers, as a claims representative for over 12 years, and without exception, across 4 different insurers, this is exactly what I experienced.

While legally this is a "bad faith" practice it is more widespread than most believe. Several of the companies I worked for paid bonuses and incentives to lowball and/or deny claims. Many states have began to legislate against this practice.

There is good information here if you want a reference:

Posted by Anonymous on 2011-04-19:
leet60, I apologize for how my comment sounded. I didn't mean any offense. I can understand where you are coming from but I can assure that Aflac does not do that. I read the webpage you provided the link. I don't understand how the companies could get away with it. I was not there so I can't say about other companies, I can only say about my experience. I can see were you are coming from. But in my experience, most people don't take the time to read the coverage they sign up for. For example, people getting upset because they have an accident policy and they were treated for a flu. No insurance covers everything and people need to know what they are paying for before they have to use it. We are all guilty for not reading policies, contracts, etc. And it is difficult to help someone over the phone because they tell you one thing and you help them based on that and then what they send in is completely different from what they told and then they are upset because it is not covered. I can go on and on. But my point is that they are an ethical company and more people have had a positive experience than negative and the negative is not the company's fault.
Posted by jktshff1 on 2011-04-19:
sia, how are you able to "assure" that Aflac does not do that"?
Posted by Anonymous on 2011-04-19:
I used to work there.
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