NEW YORK -- I have been paying for Aflac for years with no claims. I finally had to have surgery. I have never had a more obstructive, difficult or opaque claims process. Everything has to be mailed or faxed, despite the fact that they say you can upload documents online. When I tried to start and online claim several times, those claims never showed up in the system and the claims representative couldn't find it. My mailed claim is still not in the system 5 days after delivery confirmation and I had to go through 2 people to confirm that they even got the documents.
They do not email or call (ever). They only send you a notification that the claim was denied (first try) because I did not have the correct supporting documents. The documents that would be sufficient are never detailed. I have paid more for the insurance than even the claim, and I doubt very much I will get that. Save your money and put it is a savings account - not worth the frustration and hassle even if you do ever get something. I wish I had read the similar reviews first.
AUSTIN, TEXAS -- It's funny they advertise approving claims within 4 days. Took them a month to say they got the paperwork I had sent in twice. Maybe 20 phone calls and at least 10 different reasons of why they did not have it or one of the times they said they only received a claim form and no other paperwork. Then later on another call they said they had received the paperwork. They finally send a check for 500.00 and they did not pay for something I sent paperwork in for.
I called again and she goes "You're right we did not pay you for that." So a week or 2 later I get another check of 250.00. Someone I know who had the same exact accident and surgery has received or 1000.00 so far and he did not submit the paperwork they had forgot to pay me for. AFLAC IS A WASTE OF TIME AND MONEY. You would be BETTER OFF SAVING MONEY IN YOUR OWN ACCOUNT THAN PAYING THEM.
OGDEN, UTAH -- I would give it 0 if I could. I was a good customer for 4.5 years and when I got married I called in today (September 9th) during our company's "open enrollment" period to cancel because I have full coverage on my husband's insurance. They would not let me cancel. They told me I had to wait till next June!
Even though they told my supervisor a few months ago that she needed to wait till September for our company's open enrollment. We work for the same company! Do they just make this stuff up as they go? I feel like we are getting the run around. Whatever it takes to get more money from us. Never again!!! Think twice before you deal with this company. Too many bad reviews.
Unfortunately I became disabled April 3, 2010 due to illness. My policy, unannounced to all of the other employees within our company were given a 30 day waiting period before the Insurance kicks in. That in itself was part of the problem and I blame the agent for not disclosing\emphasizing that. However after the 30 day period I processed the paperwork given with all due diligence. The paperwork was delivered to the local office along with the medical history from the Doctors\Hospital stating my condition clearly and this was very early May. They were in possession of more paperwork than most people filing claims provide.
On May 13, after days of sitting idle at the Columbus office AFLAC processed the claim. They paid me $66.67 cents because my doctor did not supply the next appointment date as he wrote on the (Number 6 line) permanently disabled instead feeling that ongoing appointments were understood. One would think that a company the size of AFLAC would call the Doctor Office if needed and get the required info. Lord knows they request a person's whole life's history in other cases. Nonetheless they did not and the claim was approved for 2 days of disability. I did not know this until I went online to see the status.
At that point I called AFLAC directly and asked why this was happening and found the reason stated above. I was told the paperwork to resubmit the claim would be included along with the check for $66.67. I asked them if the form was available online and they said yes. At that point I located the form, resubmitted it my Doctor to fill out again and explained why. Needless to say the Doctor's office was not pleased having to fill out yet another set of identical information because of a missing appointment date. They FAX'ED the info to AFLAC on May 13th.
After two days I contacted AFLAC and asked what was up with my claim and they said it would be next week Tuesday before it gets processed. I mentioned I needed to let my company know about this problem and ended the conversation letting the individual know that I told them I was destitute and needed this Insurance that I have paid for since 1998. I received a call from my agent's boss Friday afternoon apologizing for the delay in returning my calls and again I explained the problem. To my surprise shortly after that the claim went from nothing Friday into processing.
Today is Monday May 24th 8:56pm and it is still processing. It appears that Tuesday is the day the woman told me it would be is what will be. Their cycle, that will be followed no matter how desperate the customer is. I did not plan to have my disability happen to me that is why I bought the Insurance many years ago in 1998. Now that I need it I am getting the run around, like cross the T's and dot the I's or you will be set aside.
Be careful fellow workers. All is not what appears to be when an agent sells you insurance even if it sounds like a good company. If you are relying on this to help during crisis as me you need to have a backup somewhere. If you do not you will receive a 5 day notice to pay up this past months rent or vacate. Tough and sucks to be me!
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 it's 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 holder's 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. It 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 it 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, it's 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. It 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.
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.
PASADENA, CA -- I have been an AFLAC agent for six years. I am surprised to hear that some have been unhappy about the service or products. To ** from Houston of Houston, TX on 9/10/2008. It is impossible for AFLAC to lose a fax. Their system is completely electronic. Faxes are viewable on computers only after they are received. Each fax is chronologically logged.
If you send a fax to ensure that it was received note the time and verify with AFLAC that it has been received or print your confirmation. Just give the representative the date time and phone number they can track the fax. Many times multiple pages will go through the claimant's fax at once resulting in “a page missing” at AFLAC. Your money is worth assuring that the pages feed through the fax properly.
The customer service representatives are required to give full first names at the beginning of each call and last name when asked. As with any business, problems do arise. You may also ask for a tracking number. A tracking number creates an ongoing log until your issue is resolved.
Ask the representative to repeat the questions you asked during the call and to review their answers to your questions that is the information that will be within the tracking number. The next time you call give the representative the tracking number. I would never stop paying my AFLAC, which I purchased before I became an agent. Claims are usually promptly paid within three days and I have a check in hand within 10 days.
To ** of New York, NY on 9/9/2008. I am sorry that your agent didn't explain the Short Term Disability to you very well. Here's how it works. Any claim in the first 30 days for sickness (pregnancy included) is considered pre-existing. All sicknesses claimed in the first 30 days require a waiting period of one year. No claims will be paid for that year for that illness.
If you take a maternity leave due to complications of the pregnancy within the first 10 months you own the policy here's how it works. The day you take leave is the first day of your elimination period. AFTER your elimination period is exhausted AND BEFORE the baby is born is the first day you may claim. Your claim ends the day the baby arrives because you haven't owned the policy 10 months.
If you have owned the policy for 10 months or more at the time of a claim; your claim begins the day after the elimination period is exhausted and ends on the day you are released from the doctor's care to return to work or the benefit period you purchased is exhausted, even if you take more time off to be with the baby. Short Term Disability Accidents occurring after the effective date are payable immediately.
To ** in NC on 9/8/08. Your agent sucks! Anyway the claims fax number is on the bottom of all claim forms. The reason you couldn't cancel is because you participated in your company's Section 125 Cafeteria Plan. You are required to participate for one year and should have signed paperwork that stated that you were aware of this rule.
To ** in Portland Oregon. I offer my condolences to you for the loss of your wife. You're agent should have informed you that AFLAC is not a primary insurance plan. It is designed to assist with paying the co-pays, deductibles and out of pocket expenses associated with being ill.
All AFLAC claims require documentation. The hospital bills, history and physical, and chemotherapy records and receipts should suffice to process the claim. Each claim is broken down by the payable event i.e. chemo, radiation, hospital stays, etc. If you discover paperwork that you don't think you were paid for event though you no longer own the policy you may still submit a claim for uncollected benefits. The claim form alone is not enough information to process a claim.
To ** in Frederick, MD on 7/19/2006. Your company is jerking you around AFLAC does not collect funds for the Dependent Care Account. It is held by your employer after deducting from your paycheck and the employer cuts a check to you from their account. Many times I have had companies using the employees' funds to float the business. It sounds like this is what has happened to you. As long as you submitted for reimbursement each month after the care was provided you should have the money back.
Many people don't understand the getting started in dependent day care is expensive to get started. Example 1/1/2009 you pay the caregiver and your deductions also begin. On 1/31/2009 you may claim for the first month. 2/1/2009 you have to pay the care giver and you deduction for the second month continues. 2/10/2009 you'll receive the first reimbursement. You've already paid four months in five weeks before the first reimbursement. Good luck to you all!
DALLAS, TEXAS -- I signed up for Insurance in December and tried to cancel because I realized I have to pay out of pocket first and then they will reimburse me and I just didn't have the upfront cash. The first time I called and cancelled it wasn't done. The second time I called to cancel they said they didn't see any notes of me canceling and charged me. Told me in order to get that money back I would have to fax them a letter stating what happened.
I decided it was too much of a hassle and forget it. It was just $30. Then I was charged the 3rd month and when I called and explained everything all over again they told me this time they had notes and would send me a refund check. They never explained that I would need to send a signed written note again. A week or two later (now) they send me a letter instead of my money saying that I have to send them a signed written authorization to verify that I want to cancel. What?
Was my word of mouth over the phone 3 times not good enough? Did the fact that I gave them all the security information they needed to know that I am the policy holder? Did I not already give you over $200 a month that I never used? And you are telling me you can refund me back my lousy $30 (only by check, of course).
They make it very easy by going through your bank and having all access to your account to take my $30 monthly but when you want your money from a mistake that they made you have to go through a process. This is the worst service I have ever had and I will tell my company that employs over 300 people, that let them come in monthly and offer their services, to not receive anymore services from this company because of the turmoil they will take you through. It is cheaper and the customer service is better with a real insurance company and less of a hassle!
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 AFLAC 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 its 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.
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 is 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 anyway, 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-existing. She new this, but hoped it would pay anyway. There is a reason we are a Fortune 200 company. We really do help people when they need us.