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Posted by Dirtydave on 04/30/2012
COLUMBUS, GEORGIA -- About nine months ago during open registration at my place of employment AFLAC put on their Dog and Pony show about what great supplemental health insurance they were and how they would help pay your bills, etc. What AFLC doesn't bother to tell you is that they make filing a claim that they will accept as difficult as possible. They have already denied a perfectly legitimate claim from me. I was looking into filing a claim for my wife, who was recently injured at work, when I discovered that AFLAC expects you to provide their claim form to the physical while you are being treated for the accident. So while you are in the middle of an emergency you are expected to stop, logon to the AFLAC website, sign in, download and print the claim form. Perhaps AFLAC thinks you should download and a keep a copy of their accident claim form on your person at all times in the event that you might have an accident sometime in the future. Most of us don't have time to make an appointment with an attending physician after an accident to have them fill out an accident claim form, and most physicians are too busy treating the patient to take time to fill out AFLAC's accident claim form. Is this a criminal action? Sadly no, but it goes beyond unethical. I understand that AFLAC is in business to make a profit, and I am sure they do quite well by making it as difficult as possible for it's customers to file a claim. They might want to add the requirement that the accident form be signed with the blood of a Virgin, during the dark of the moon. The board of directors should be all over that idea. Anything to sweeten the bottom line and up those bonus dollars.
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Posted by trmn8r on 2012-04-30:
Can't you have the doctor's office fill a form out after the fact? Seems to me the staff could do it, but maybe I don't understand the issue.
Posted by jktshff1 on 2012-04-30:
Good post, thanks for the info & heads up
Posted by Anonymous on 2012-05-01:
How are they supposed to review a claim without claim information? Are they supposed to be mind readers. Generally, it is easy to file an accident claim although their can be some difficult situations. If their is an emergency, you should focus on the being treated first and filing a claim last. When treatment is in the ER you don't have to have the forms filled out, you can get a copy of the ER report usually the next day, but in some cases the discharge summary will suffice and this is given to you upon discharge, if not ask for it, make sure it shows the hospital's info, diagnosis and treatment date which it normally does. Be sure to include a brief written statement giving complete details of when and how the accident happened. This is not difficult. No one expects you to stop what you are doing to print out a form during an emergency. If you do that then you need to re-evaluate your common sense and priorities. If it is difficult to get information together, due to a busy schedule, I can understand that. There are no time limits on filing a claim and if you need help getting the information Aflac will help. Simply have the patient fill out the claims authorization form, provide a statement giving the date and details of the accident, dates of treatment and name and contact information of each health care provider for that treatment type of treatment recevied. For example: I fell on such and such date, I went to ER at such and such hosp - their contact info, mri at such and such - contact info, and so forth. The time it takes Aflac to get the info can vary as they are at the provider's mercy on how long it takes to respond. Some respond quickly, some takes awhile and some do not respond. This is not Aflac's fault. If you can get the info yourself it will be much faster. I'm sorry but we do not live in a perfect world. But I imagine if we had technology hundreds of years in advance, and people get paid immediately on the spot an obscene amount of money, they would still complain. Some people's attitude's are they will submit the claim tomorrow but they should have been paid yesterday. Of course no company is perfect and humans make mistakes but the thing I noticed in each different industry I have worked in, is that the those who do not have valid complaints usually complain the loudest. I just don't understand, you apologize for an error when a customer brings it to your attention and you apologize and they are like, that's ok, mistakes happen. But customers with invalid complaints often want to get ugly. I'm not saying that you don't have valid concerns but you have the wrong perception on how things work. I'm not trying to mean but I like to see people get full benefits out of their product. You can really be cheating your self if you are not careful and the company want know because you don't cooperate with them helping you. For example, I had an experience where someone called to find out if something was covered. Unfortunately it wasn't. However, there were many other benefits that was covered and would have been a pretty good amount and would have helped this person greatly, and to top that they were very easy to file for. Because this person was so focused on the one situation that was covered, and everytime I tried to tell them what they could receive, I kept being cut off and not allowed to explain and the person hung up without finding out. You can't help people who don't want to listen, talk over you, cuss you. When I have a problem with a company I do business with, I am respectful to the representative and often get results. I have a family to raise and like everyone else have problems but I don't blame my misunderstands on the company. Glad I don't deal with things like this anymore. Never again will I work in a call center
Posted by Lboots on 2012-06-09:
I just dumped AFLAC after have them for over fours years. I had four policies with them and the other thing I have EVER received from them was wellness exam money...100 dollars or 150 if you had an MRI. However, I had a claim for an animal bite...was seen in the ER...received a bill for 125.00 dollars...filed a claim with AFLAC that claim rejected. Received a bill for 494.00 for other medical services I had done. A bill my "major medical" did not cover...again rejected after I submitted it to AFLAC.
AFLAC claim forms are basic. You submit them..they requested additional info...I faxed it. They reject it. The company is a scam. I could have taken what I paid monthly to them and invested it. I am very angry with this company.
Posted by Anonymous on 2012-08-13:
Lboots, Aflac policies are very specific as to what the cover. What type of policy do you have? If you have an accident policy, the trip to the ER would have paid you for the ER visit plus a laceration benefit. If this is the case then you obviously did not submit the correct documents. The cost of your medical bills do not make any difference and what your major medical covered or did not cover makes no difference. Most people don't want to take the time to read their policies and then want to be angry when your claims are not covered. Just because you claim is not covered does not mean they are a scam. If it was denied then its just not covered under your policies or you didn't submit the information they told you is needed.
Posted by Stacey on 2012-11-08:
We have had aflac for 5 plus years now. We have never had a problem filing a claim. We just submit the doctors information and once we get the message in our aflac inbox print and send it in. That's all we have ever done no matter what the case may have been. Then once its sent in takes about 7 days to get our checks in the mail. I am submitting claims for a few years ago since I didn't know they covered certain things, now that I do, I can go back and submit. Sorry for everyone having trouble. We love aflac.
Posted by Benji on 2013-09-27:
I guess maybe it is different from state to state but I live in Iowa and have had 3 major accident claims between my wife and I and have never had a problem. I highly recommend AFLAC as supplemental insurance. If it weren't for them we would be in medical debt over our heads. They have always paid above what my actual expenses were so she could cover lost time at work as well.
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Because I get a check in three days does that make everyone else stupid?
Posted by Mknk11 on 04/10/2007
RICHMOND, INDIANA -- Typical post from an idiot who receives a check from Aflac in three days and therefore anyone who has a complaint is a fool. What a moron! Aflac sucks. Just try to contact the call center. Be sure to block out about 60 or 70 minutes of your day though. I have always suspected there were only three phones at the call center and two people answering. You do all of the paperwork for them and they simply decide whether they want to pay or not. My policy was not cheap and by the time I make all of the trips to get paperwork filled out and signed and then faxed, it definately comes out in their favor. Aflac has lied to me on numerous occassions and if I hadn't kept detailed records, they would have screwed me bad.
Go cash your Aflac check, fool. But let me assure you that they're not doing you any great favor.
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Posted by Justusryan on 2007-04-10:
Posted by Big Al2674 on 2007-10-27:
I've also experienced very poor customer service while processing a claim. Aflac always pays the little stuff quickly but I'm have lots of trouble trying to have them pay a large claim. Aflac seems to lose my faxes and paperwork.

My advice: when you see an aflac salesman coming to you RUN AWAY!!
Posted by Turbo3077 on 2007-12-24:
I'm sorry that you had trouble. However, while I can't comment on your specific situations, I know that the Aflac Claims Department looks for reasons to pay claims. They are also instructed to look for other benefits to pay that you may not realize you are entitled to. When you file your claim, you should check your policy to see what you are entitled to. While reviewing your claim, the claims specialist has to go by what is stated in your policy. I can't comment on your exact situation as I don't know the details, but I see many comments on here that the claims dept are idiots or whatever. They have a very difficult and frustrating job at times. It may seem easy until you try to do it for yourself. That's not to say the person who reviewed your claim didn't make a mistake because they are only human. Sometimes Doctors don't make somethings clear or some of the information that is needed is not included. I can go on and on but the bottom line is, I haven't seen too many companies that go over and beyond for there customers as they do.
Posted by Dave R on 2008-03-20:
AFLAC's customer service is what it is. You call the 800 number, you enter you identifying info, then select the department you need through the phone tree. Sound familiar... It like any other large business that handles thousands of calls every day. If you think there should be someone sitting there with their hand on the phone waiting for you to call just so they can pick it up quickly, you will be sorely mistaken. They have peak calls times and slower call times. I know, I am an agent on the West Coast and have been for years. Call them first thing in the morning Tues-Thurs and you will save yourself a lot of hold time. You are correct, 3 day turn arounds on small claims like the Wellness benefits are easy and they should process quickly. If you have a large claim and are slow or having trouble getting them the necessary info or submit an incomplete claim form, it will take longer. There's no mystery. Some claims are more challenging that others. I have had some claims process within a couple days of faxing them in. When volume is high or its around holidays when people talk time off, claims process slower. And, excuse me, but even I as an agent have had my challenges with AFLAC. Just a couple weeks ago I helped a person submit their claim and it came back $500 dollars lighter than it should. I had to call the claims department back and have them send it in again for review. They did, and about 10 days later the woman I helped got her additional benefits she had coming to her. The person on the other end of the phone is only as human as I am. For those having trouble with claims, which seems to be the common issue, have the agent that sold you your policy help you. I spend about half my day trying to work things out for customers and claimants. I work with AFLAC claims so it is easy for me because I know what forms need to be filled out, who needs to fill them out, and what AFLAC needs to see in order to pay the claim. Make the agent who sold you your policy earn his/her money. Many of the complaint posts have the same common theme, "AFLAC doesn't want to pay my claim", "They are stalling by rejecting my claim for", "I can get anyone over at AFLAC to help me", etc. ALL THESE ARE PROBLEMS BECAUSE THE AGENT WHO YOU BOUGHT FROM ISN'T DOING HIS JOB. You should never have to wait on hold for an hour, and you should never have to file a claim without the assistance of your agent if you need it. Call you agent, call you agent, call you agent. Don't call AFLAC because all they have to work with is what you or your doctor send them. If it isn't what they need they can't help you. All they can do is send you more paperwork to fill out right the next time. And always read your policy. It is what it is, no more no less. There are guidelines, limitations and exclusions, just like any other insurance policy. This is not exclusive to AFLAC. If your agent told you your policy would do something that it doesn't do, it is not up to AFLAC to honor that. Call your agent, call your agent, call your agent.
Posted by gladgrad on 2008-06-19:
If you have a problem or are confused about how to make a claim...CALL YOUR AGENT, OR HIS/HER DISTRICT COORDINATOR OR THE REGIONAL COORDINATOR.. I assure you, these people care.
Posted by Grtcvg4u on 2008-12-02:
Why are you using Customer Service and not contacting your agent to assist you with your claims. A good agent never refers their policy holders to an 800#.
Posted by AngelicaW on 2009-01-18:
LOL Grtcvg4u...I'm guessing you're an agent :) I work at the call center, and I love the agents that I have spoken with. However, there are many bad seeds out there, those that instruct policyholders incorrectly, either on how to file their claim, or even what they are entitled to. The best thing to do, in my opinion, is to get the customer straight to the source for a direct and certain answer. But since you're on this site posting, I'd like for you to keep servicing your clients, because you obviously know what you're doing. :)
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Aflac Corporate Is A Joke
Posted by Seriously on 02/11/2008
IOWA -- Our company started with Aflac in early 2007. The rep here is good, but even he was frustrated at how incompetent the corporate office has become. I will explain.

Each time we had an employee drop the plan it took months for AFLAC Corp to remove them from the billing. So we paid the billing short with a copy of the dropped status a check with the account number listed in the memo portion of the check.

November, December of 2007, January and February of 2008 they cashed the checks but in turn sent everyone in our company a letter stating that the company has failed to make the payments and their insurance will lapse unless they pay ALAC directly. They sent our company a notice for those months also that they were canceling our policy due to nonpayment. We have been in numerous phone conversations with the rep and their corporate office. The rep understands but the Corporate people can't figure out the problem.

Needless to say we are now canceling what I think is a decent policy, but incompetence can ruin a company.

I would not invest in their stock or their product until they get control of their corporate office.

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Posted by Suusan B. on 2008-02-11:
Check your policy - - I'll bet somewhere it states that it can take 2 to 3 billing cycles for billing to stop on cancelled accounts. It's never a good idea to short-pay business accounts - - particularly those for insurance.
Posted by Dave R on 2008-03-20:
Here is your solution: Internet Billing. I have worked with AFLAC as an independent agent for many years. I can tell you the good the bad and the ugly. AFLAC no has hundreds of thousands of payroll billed accounts. Manually billing is now becoming obsolete. Its like paying with a check at a restaurant verses using a debit card. Manual billing is slow and sometimes does take several cycles before it shows updated. This is because of the date prepared, the date the account actually put invoice in the mail, the additional time involved with mail, and the time it takes AFLAC to manually adjust the bill when changes need to be made. If you receive your bill and hold it for 3-4 weeks before paying it, AFLAC is already working on your next invoice which may already be in the mail. This is what causes the adjustments not to show immediately on your next invoice. Internet billing fixes that problem. You get an email with an invoice, which takes a computer seconds to generate and send out. You pay on line and make adjustments to your bill online. Then hit the submit button. If you pay over the internet with E-Check, your invoice will reconcile within 24-48 hours. So, I will have to stand by AFLAC on this one. They created internet billing to solve this problem, as it was a problem.... in the past. Hope this will help and possibly help you to reconsider continuing your service with AFLAC. Thanks.
Posted by truthbknown on 2008-05-11:
I would also request that the person who posted this comment take a look at Aflac's stock history. Thank God this person is not a financial adviser. They wouldn't get much business.
Posted by BOOTER on 2008-05-23:
Thanks for sharing--PLS, NOTE MY RECENT POST--STARTS WITH''i amm 66---
Posted by Oklahoma5 on 2008-11-03:
Internet Billing is the only way to go.
Posted by Grtcvg4u on 2008-12-02:
The billing issues have been frustrating at times but your employees will need this coverage nonetheless. Sounds like you have a good agent, hopefully they were able to resolve the issue and convince you to keep your benefits.
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Lies, broken promises...but no money
Posted by AflacSucks on 01/12/2007
I've already written a very long, very comprehensive rant about Aflac which can be viewed here, so I'll keep this relatively short.

Aflac LIED to me--not just to me, but to my husband, my daughter, and my brother, all of whom spoke to them on numerous occasions, both via phone and in person over a 1-1/2 year period. I had an unusual set of circumstances, i.e., one accident that occurred at work followed by a second, unrelated accident that occurred at home, but BEFORE I had returned to work from the first one.

For 1-1/2 years we were told that as soon as my workers' comp benefits ended for the first injury, Aflac would begin paying my benefits on the second one. But once we filed the claim, they suddenly decided that I didn't qualify for benefits because of a "continuation" clause in my policy, i.e., since I had never returned to work following the first accident--which they DEFINITELY knew about--the second accident, although totally unrelated to the first, was considered a continuation of the first.

So why didn't they mention that during the 1-1/2 years that we were continually told they'd start paying benefits once workers' comp had ended for the first injury? Hmmmm...I wonder if it had something to do with wanting to keep collecting my premiums! How convenient that NO ONE at Aflac thought about the "continuation clause" until AFTER I filed the claim.

We documented every phone call with the name of the person we spoke to, the date, the topic(s) discussed, etc., so unless Aflac just wants to blatantly lie about these conversations, even they would have to acknowledge them. And they'll have their chance--in court. I'm currently exploring suing them, both personally and as part of a class-action lawsuit. Based on the hits my "Aflac complaint" page has been getting, and the search terms that led people to it, it's quite clear that I am by no means the only policyholder who has been lied to and cheated out of benefits I paid for.

The bottom line, in my humble opinion: Aflac sucks. Pure and simple. Run in the opposite direction if you're ever approached to buy policies from them.
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Posted by AflacSucks on 2007-01-13:
I didn't realize HTML was disabled, or that posts can't be edited (at least I'm not seeing a way!). So my post refers to "here" which should have hyperlinked to this page, which is my long, comprehensive rant about how Aflac has screwed me, www.smartassproducts.com/aflac.shtml
Posted by tnchuck100 on 2007-01-13:
If you are part of a class action lawsuit you are probably barred from suing them independently. If you have not joined an active class action lawsuit you are probably better off in your case.
Posted by Anonymous on 2007-01-13:
Agreed with tnchuck100!
Posted by WordToTheWise on 2007-01-29:
DO NOT underestimate the moral turpitude of the Aflac sales force. I was once...one of them. I could tell you stories for d a y s about the fraudulence and misrepresentation that salespeople brag about. It's grotesque. The worst part about it is that my wife is an administrator who was promised the moon to take a position on the other side of town, only to find that she was sorely mistaken for trusting them. I could go on and on.
Posted by Dave R on 2008-03-20:
Hi. Its been a while since any new posts. I had a question.... you mentioned in on of your write-ups that you had 5 different policies. Based on your situation and chief complaints, it appeared as though it was the Short-term disability that was not paying. Did you file your claims under any of the other AFLAC policies while they were in force? It looked as though you had at least a hospital indemnity plan. Did you by chance have the accidental injury plan also? Both of these plans have on the job benefits and off the job benefits. I was just curious because I didn't see anything more about that. I will help you file these claims if you haven't done so. I am an agent on the West coast. I am sorry to hear of your troubles.
Posted by grommie on 2008-04-16:
I knew better than to accept them at their word, but no i had to jump on the band wagon and follow everyone off the cliff! Six days ago i was told my money would be here 2 days ago. Just today, and 6 weeks after it was filed, my agent told me she made a mistake on the claim. UGH! She said she was always too busy to help me. I asked her, can you not talk to them now?? She said, no, she is on her way to Little Rock Arkansas. I said, well I am cancelling my policies with AFLAC. (I don't even care if I get any monies now.)
Posted by gladgrad on 2008-06-19:
I work for Aflac and these agents who are some of the best people I have ever met.. I've never seen or heard any fraudulent or misrepresentative behavior, in fact, I've seen tireless efforts go into making cliams for clients day in and day out.

I don't know what office the above ex agent worked in but here in California I've seen the exact opposite.. If his claims were true I wouldn't be working there..I'm doing Aflac until I can get into nursing school. In our office customer service is key because word of mouth is so important. We stive to work 100% on referrals. If our clients are unhappy the company will not suggest other companies to go into..It's like shooting yourself in the foot.
Posted by 1960 Stratocaster on 2008-10-16:
If you were in a decent relationship with your past employer and had gone to her/him to substantiate that your wrist incident did not happen on his or her "watch" - then it seems to me that Aflac would have come through for you? All the employer would have to say, "I am not aware of a wrist accident happening to _______ while she was working for me."

That small step would have been enough for Aflac to follow through and pay your claim, at least it appears as such to me?

Aflac cannot split hairs over who is and who is not on good terms with previous employers. You said that you previous employer did not know about your broken wrist. And that is all Aflac wanted to establish. All they are seeking is final confirmation that the wrist accident was something that your previous employer was not aware of, and as such, the wrist issue is a seperate issue that happened off the job. Then they would pay a claim on it. I read your entire piece that you put together for a web site separate from "my3cents." Nicely written piece, by the way. But I do think this might have come together for you much more easily if you had received that simple confirmation from your previous employer? Robert in Vacaville Ca by Sacramento
Posted by Oklahoma5 on 2008-11-03:
Posted by Oklahoma5 on 2008-11-03:
I'm sorry about all of the problems you are having. I am an experienced agent in Oklahoma, also licensed in Texas, and have never experienced any of the things that you have written about. Nor have any of my clients. I was wondering how those other 4 policies paid? Based upon your statements Aflac, I'm only assuming, reviewed and denied your claim based on the last page of your policy brochure. WHICH STATES: Separate periods of disability resulting from unrelated causes are considered a continuation of the prior disability unless they are separated by your returning to your job for 14 working days, during which you are performing the material and substantial duties of this job and are no longer qualified to receive disability benefits.

Aflac is not at fault in the fact your agent should have told you to review this portion of your brochure.

I am also sorry that you were led to believe that you would be paid at some point in the future for a prexisting claim. (no insurance company works this way) Your agent is an independent agent, not an employee of Aflac, and can't approve or deny a claim.

Once again I do hope that everything works out financially, emotionally and medically for you and your family.

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Perspective from a customer service representative
Posted by JacksonSlade on 12/13/2009
As a customer service representative for Aflac for five years, I know how the internal processes within the company work. I see what is sent by the customers to be reviewed by the company, I see how quickly a claim can be processed but also see why a claim can be delayed.

The most general problem I see is insufficient information being sent by the policy holders when they file a claim. Each line of business, whether its a cancer policy, accident policy, etc., requires specific documentation to process a claim. What I also see are policy holders filing claims on a specific type of policy that doesn't fall in that line of business. For example, a visit to the emergency room for the flu will not be payable under an accident or a cancer policy.

I do understand the policy holders frustrations, based on the sheer volume of claims filed with the company. Every claim has to be looked over for the correct information, verified as being correct information, and processed. If the correct information is not received, the claim will be pended until that information is received, Aflac can contact the provider to assist getting it, but the provider will not comply without written authorization from the policy holder to release medical information, its is all tied up within the HIPAA laws, protecting personal medical documents. If the authorization is not submitted with the claim, then a letter is sent to the policy holder requesting said information.

As a customer service representative in Aflac, I don't get a lot of calls saying how bad a company we are, don't get me wrong, I get them, but is is usually a call that can be simply rectified with the correct information being received. I know faxes get lost, sometimes don't make it through for whatever reason, mail can be lost, it is inevitable with the sheer volume of requests sent to the company.

I deal with complaints the whole 8 hours I am on the phones taking calls from policy holders and agents. The system sure isn't perfect, but what system is? For every one call I get from an irate customer, I get 100 more from people who flatly state they would not know what they would have done without Aflac being there for them.

If I could give one piece of advice to policy holders, is this. PLEASE read your policy, know what you have benefits for. The Customer Service Center is not just about complaints, if you need assistance and can't find your agent, the Customer Call Center can instruct you of what benefits you have and exactly what documentation is needed to process a claim for you. If it isn't a claim, but policy information, or a problem with an account deduction from your paycheck but not submitting your premiums for payment in a timely manner, we can help you there as well.
One more piece of advice. As a Fortune 500 company with over 5,000 employees, there are many departments and many processes, which take time to complete. I understand that to any caller, I am Aflac and when I talk to them, I represent all 5,000 employees. I, however, am one small cog in a giant machine. It is the nature of the beast, I imagine all very large successful companies operate this way. I can do my best to help someone calling in with a problem, but 99% of the time, I personally cannot fix it, the request has to be sent to another department, escalated for sure, but everything takes time. Instant results are extremely rare when some type of problem arises.
We do our best, day in and day out. It isn't helpful to a Customer Service Representative to be screamed at and cursed upon, called names, that just elevates the Rep's level of frustration. What I see most is people calling in yelling and screaming, not giving the representative a chance to even find out what the problem is and trying to ascertain how to expedite a solution. If you called in for assistance, let us assist you!!!
I know there are policy holders out there that are unhappy, for every one of them, there are 1000 or more satisfied customers. If you are unhappy, try again calling to understand what happened, be patient, calm, explain the situation, let the customer service representative look back over the problem to see exactly what can be done, if anything, or explain why this event actually occurred.
Aflac is the best company I have every worked for. I bothers me that people out there bad mouth the company, and I can understand some of that, a policy holders frustration or anger could be the result of a problem that could be resolved simply.
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Posted by NanS123 on 2009-12-13:
Well said. AFLAC is an excellent company to work for, I sold insurance for them for a couple of years, but left due to personal constraints. Eventually I'll go back and sell insurance for them again, they stand behind their products and their employees.

I also work in customer service now and agree with you 100% that when people call in yelling and screaming, it can be very hard to help them, especially if they won't listen to your explanation. Hang in there, I feel your pain on those types of issues.

Happy Holidays :)
Posted by Ponie on 2009-12-13:
I've found that when trying to solve a perceived problem, if I approach it calmly neither I nor the CSR will have a spike in BP. Even if the resolution isn't to my liking, there is no need to rant and rave at the person on the other end of the line. Good review!
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Ripped off by AFLAC
Posted by Vals24car on 05/24/2009
LOS ANGELES, CALIFORNIA -- AFLAC is it real or too good to be true. Every firefighter has been approached by several insurance representatives that have claimed that they have the right product for your needs. We all have seen the commercials where you see an injured person in a cast sitting there and the AFLAC quack with money. If you are injured and cannot work, AFLAC will take care of those little things. This may be true for some but not for many.

I have always paid my premiums on time, believed if you do the right thing it will come back. What you are not told by AFLAC is that you need to maintain your personal medical records and when you have a claim and the documentation your claim may be denied. This specifically is what you need for an accident claim.

• Follow-up care (included a list of treatment dates on the doctors letterhead or prescription note pad…this includes copies of the medical bills).
• Physical Therapy (Include a list of physical therapy treatment dates on a doctor’s letterhead or prescription pad and copies of the bills).
• Employer’s Report or Occupational Report – 166’s (if your injury happened IOD).
• X-Ray Report – (if there was a fracture).
• Police Report – (if you were driving a vehicle involved in a traffic accident)
• Ambulance (Proof of such an ambulance bill or service invoice).
• Crutches, Wheelchairs, Leg braces, Back Braces – Include proof of any ambulatory device.
• Hospitalization – (Itemized billing from the business office of the hospital if you were there for over 24 hours due to an accident).
• Operative report – Include this report from your doctor if surgery was required to treat your injuries).
• Accidental Death- (Include a copy of the death certificate).

What they do not tell you is that you will only get reimbursed for six doctor visits and six physical therapy visits. I was not informed of this till I gathered 45 physical therapy visits and 15 doctor visits for one shoulder incident. I still have several years of two bad knees to battle with them.

If you have an IOD accident they may pay your claim. Personally it took over three months to get copies of billing and doctor’s reports from TriStar. In the event of a death of a member you must prove that you have the durable power of attorney, copies of marriage certificates just to access records.

If you have a Personal Recovery Plus policy, you need all of the above in addition, it is up to you or your family to see that all of the paperwork is completed and still the claim may be denied. The Personal Recovery Plus policy only covers Heart attacks, stroke, coronary artery bypass surgery, end-stage renal failure, major organ transplants, major third degree burns (not 1st & 2nd ), coma and paralysis. Please note that there is a difference between a heart attack and cardiac arrest and cardiopulmonary arrest and that is only one will pay you on your claim. The money is not much but the principle is. My advice to you is to check your policies very close so your families will not have to endure more losses. The loss of my husband is devastating and knowing he wanted me to be taken care of and not taken to the cleaners by AFLAC. If you do not like what you see only you can change it. I did and cancelled my remaining policies with them.

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Posted by Anonymous on 2009-05-24:
A fried has AFLAC through her job and is out due to a back injury. AFLAC denied her claim because she did not have an "accident". Seems they only pay if the injury of the result of an accident. She and her employer could only say she had lifted a item and caused her back to go out. AFLC does NOT consider this an accident, evne though her employer says proper procedure was followed.
Posted by trp2hevn on 2009-05-26:
Raven, did your friend have only an "accident" policy? I think it depends on what type of policy that someone has. Maybe she needed to have something like a "short-term disability" policy or something like that.
Posted by Anonymous on 2009-05-26:
Nope, according to her HR admin,as well as the folks she spoke with at AFLAC, AFLAC only pays for "accidents". Their regular disability coverage did pay, but AFLAC is supplemental insurance that only pays in certain instances.
Posted by wijeke on 2009-06-23:
If it wasn't an accident then it would be under sickness which has a longer waiting period. Policies vary from state to state, but if she has been out long enough it should start paying her for that.
Posted by Freddie G on 2013-11-15:
I bought four polices from AFLAC, knowing that at some point I may need them. Guess what... At the end of Sept. I had a heart problem and checked myself into a hospital and ended up in a cath. Lab wth a pace maker put in me. I did everything AFLAC asked of me and still I'm under a review. So frustrating , so far this has cost me out of pocket 200.00 to get all there paper work filled out. I'm beginning to think that it is a SCAM. I don't think it's going to come out well on my end.
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Do Your Homework
Posted by Mramsouer on 10/08/2010
I have been an agent with Aflac for over 5 years. After reading several of these complaints I am very upset. Aflac is one of the most ethical companies I have ever worked for. They don't try to find ways to not pay claims like heath insurance companies do. As consumers, you need to do your homework when purchasing the products. As agents, we only can give so much information when presenting to companies or employees. Employers tend to not want us to be there for very long. Our products are black and white. We ask questions upon signing up clients and based on their answers a policy is issued. Like any company you have good and bad. If you go to a restaurant that you really like the food, but the server was horrible, are you never going back again? It is also your responsibility to read your policy when you receive it. I have heard people complain that Aflac doesn't pay, but then when you get into the details you find out that they misrepresented themselves or didn't give all the info. They just want to vent because they didn't get paid! This isn't insurance to make money, it is for protection in the event you are hurt or sick. I could go into soooo many stories of how it helped people in such a time of need, etc. but I don't have enough space. As Americans we always want to complain, but how about sharing when things do work. There are bad agents out there but there are also a great deal of us out there busting our butts for our clients. We do everything from A to Z. From enrollment, claims processing, wellness benefits and making sure you are getting the correct payment. I bet if I called on all of you complaining I would find that you either didn't have all the info together or didn't tell the truth when you enrolled. Aflac only has a one year look back for pre-existing, so remember, if you went to a Dr. and were diagnosed with anything within a year and purchased a policy then tried to file a claim, of course it is going to be denied! It's pre-existing! Most people only hear what they want to hear anyways, so I bet most of these complaints are due to not hearing what they were told or trying to get away with something when they know they aren't being truthful. My own brother's wife signed up for Aflac (disability) after going to the dr. and being told she would need a hysterectomy. When she filed the claim it was pre-exisiting. She new this, but hoped it would pay anyways. There is a reason we are a Fortune 200 company. We really do help people when they need us.
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Posted by Alain on 2010-10-09:
I found this informative. Thank you. We have Aflac short term disability and the only time my wife had to use it (for recovery time with a badly broken ankle), we found Aflac to be very good about payment according to the policy. We were pleased with their service.
Posted by clutzycook on 2010-10-09:
My husband just got AFLAC through his work. Glad to know that it's not QUITE the evil corporation that it's portrayed as.
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Misrepresentation Of Coverage
Posted by Cbrook on 09/09/2008
NEW YORK, NEW YORK -- I sat down with an Aflac representative while I was pregnant. I asked specifically what if I have complications and cannot return to work after 6 weeks. I was told that I would have a payable claim. Well, I did have complications requiring a C-Section and I cannot work for 8 weeks minimum and I was told that they would not pay the claim since I was pregnant when I applied for coverage.

I pay $55 per month for this insurance and I am going to cancel it.
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Posted by BobJohn on 2008-09-09:
Just me, but I thought that you can't buy insurance on an existing condtion (or complications of that condition) without some kind of extra rider. I didn't know you could buy any type of health insurance for $55/month. Salesman sounds rather unethical though.
Posted by jenjenn on 2008-09-09:
When you apply for disability coverage, you must go through evidence of insurability. I'm surprised they approved you for coverage with your existing condition. They are almost never covered.
Posted by Grtcvg4u on 2008-12-02:
If you purchased a policy while you were pregnant (pre-existing condtion) AFLAC would have paid for any medically necessary time off work prior to delivery but not for the actual 6-8 week maternity leave. If you had an accident or other illness during that time, your AFLAC would have covered you so it is good that you had it just in case something unexpected happened. Unfortunately it is too late for you now but in the future I always recommend reading your policy.
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Posted by Jesslindsay25 on 01/03/2011
My effective date was 11/1/2010 and I went to the doctor for a CONSULT on the 23rd and was not diagnosed with anything. I had a diagnostic test done on 12/2. My claim was denied because Aflac said that I was diagnosed on the 23. I got my records I wasn't diagnosed with anything. So I called them and asked why exactly my claim got denied. Because I was diagnosed I asked with what please hold and I held for 1.5 minutes, oh you were treated....no I wasn't what was I treated for oh please hold for another minute. So I did oh you can't have a sickness within that 30 day waiting period. SO apparently you can't even see the doctor for a visit within that 30 days....its a scam wouldn't pay for this crap. So now I'm out $500+ and I got denied what a great company.
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Posted by Hoops55 on 2011-01-05:
What policy did you have? The only waiting period is if you are pregnant or a 30 day waiting period for Cancer. Did you read your policy and know what you were buying? Don't rip Aflac and it's reputation if you were the one who didn't do their homework. Thats whats unethical.
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AFLAC is ripping off my 69 year old dad
Posted by Skootdawg on 08/04/2009
My dad is a recently widowed 69 year old man who is getting the run-around from Aflac. He has been paying on a whole life insurance policy for the past ten years, all for nothing. In May 2009 Aflac sent him a renewal form giving him the option of terming his policy or rolling it over to a whole life policy. He chose to roll it over and mailed the form back THE NEXT DAY. A couple weeks passed and he heard nothing from Aflac. He called corporate and learned via a recorded message that his life insurance had been termed. He called Aflac and they told him they never received his renewal notice. Granted he should have made a copy of the form and sent it back certified mail, but again he is 69 and recently widowed. To this day he has not received his form to fill out. He has called Aflac 5 times to get a status on this form. He finally got frustrated and I stepped in. Conveniently, even though I had his tracking number, policy number, date of birth and SS# they would not tell me anything. I asked them if they could just fax me the form so he could get it filled out and sent back, and conveniently again the agent told me it is not a form they can fax to me. I called a local agent I used to deal with and she at least called Corporate, and they told her the form was mailed out July 21, 2009. It is now August 4th and he has still not received this form!! My feeling is they just paid out on my step mothers' policy when she passed away, and since dad is 69 they are hoping he passes away before he can get the form signed! We are at our wits end with this company and the complete run-around they are giving to my dad. I would not sign on with Aflac if someone else paid my premiums! Tomorrow we will call them together just so they can tell us "it's in the mail"! A smart agent/representative would issue another form for the man to fill out. But it appears there aren't many smart agents at AFLAC!!
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Posted by BokiBean on 2009-08-05:
What a runaround!!! Sorry for your father..and I just can't stand that stupid duck.
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