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.
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!
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.
In January of 2010 AFLAC sent some agents to my job and I like an idiot signed up for Life insurance. Boy was that a BAD DECISION! My employer was taking out money from my paychecks and I THOUGHT everything was OK. In MARCH 2010 I got a letter from AFLAC stating that my policy had been cancelled due to my employer not paying the premium. My employer had cancelled checks of what they had paid.
The local representative told me that it was AFLAC's fault because they had not gotten the correct paperwork into my company's accountant. Because the original representative had quit! I was told in the first week of May that it would take 7-10 days to get a refund. My company gave me 1 month's worth of reimbursement because AFLAC was supposed to send them a check NOTHING!!!
So I called the representative she stated that a check was mailed out to me instead of my company which she stated would get the refund check since they are the ones who paid the premium. She stated that the check was mailed out on the 20th of May. Well it's the 1st of June and I still have nothing!!!
I called and spoke to a supervisor at AFLAC and he was the rudest person I have dealt within customer service. I then spoke with the representative again and all I got was "what do you want me to do?" They are all a bunch of crooks and I am going to seek the advice of an attorney. This has gone on since March. Thank GOD I didn't die and left my family with this big MESS!!!
DO NOT GET AFLAC!!! If they cannot send a simple refund check what makes people think that they will receive the services they are supposed to? Thanks for letting me express my OPINION about what a crummy outfit AFLAC really is!!!
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!
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...it's a scam. Wouldn't pay for this crap. So now I'm out $500+ and I got denied. What a great company.