We have paid for our "Accident/Disability Policy" with Aflac since 2/08. Our "Type of policy" is described as "Named Insured/Spouse" as we pay additional to cover my wife. I was told by the Aflac representative that with the additional fee, my wife would be covered as I was. Along with that we have two additional riders described as "Off-the-job accident disability benefit rider and Sickness disability benefit rider."
We were lead to believe that we both had the same coverage and shared the same benefits of the policy. In reading the very "in depth" (we'll call it) policy, one finds that the policy is mostly written in the wording for an individual policy and it would be just that if not for additional riders and fees to cover more, such as that of an additional family member.
The section describing "Type of Coverage" reads "see your Policy Schedule to determine the Type of Coverage issued: Individual, Named Insured/Spouse Only, One-Parent Family, or Two-Parent Family." Under the description for "Named Insured/spouse" the definition reads "coverage for only you (the Insured) and your spouse."
The "Policy Schedule" shows "My Name" as the insured. I understood this to mean the "Main policy holder" and nothing more. I mean.. it's got to be under someone's name. Does it not?? The important part for me is that my wife is covered as well. It appears she is as described under "Type of coverage - Named insured/Spouse" to be found on the very next line.
With all these statements in the policy we had no reason to think my wife doesn't share in all the same benefits of the policy that I would. Especially since we pay additional to have her on the policy. Recently, my wife took ill and spent 9 days in the hospital at a cost of almost 250k to date, paid mostly by another insurer thank goodness. She had two weeks of recovery time at home and off of work. We filed a claim with Aflac under the "Sickness rider" and the claim was denied with the simple explanation that "my wife was not covered under the policy riders."
To look at and see these policy documents, there is no reason at all to think she would not be covered. Then you come to the Rider and their coverage. "This rider applies to the Insured only, as shown in the Policy Schedule." Yes... I saw this. Still I thought that with the additions on the policy that it included my wife as described in "type of coverage" and as described to me by the Aflac rep. I was wrong.
A layman and simple person has no chance against some insurance companies that are out there and we feel very deceived and flat out ripped off by Aflac. We can't and will no longer recommend Aflac as a reputable company and our hope is that others will see this deception before it's too late.
Obviously, due to the extremity of my wife's illness we are now financially devastated and will work the rest of our lives (shes 40, I'm 45) to pay this off. The failure of Aflac to come through for us and help offset at least a very small portion of the amount we now owe just leaves us that much more in debt and that much more of a struggle to pay the bills.
22 CORPORATE WOODS, SUITE 2, ALBANY, NEW YORK -- On 5/23/2009 I was scheduled and had surgery on my wrist. I am an RN supervisor and have two daughters that I support entirely on my own. I took out the Aflac insurance because a friend of mine had cancer and I was concerned about my children and their future, should this ever happen to me. I took out every policy Aflac offered through my work, disability, cancer, accident, life insurance. Needless to say, this costs quite a bit of money each pay period; I had thought this a small price to pay for mine and my children's piece of mind.
I had verified prior to my surgery with Aflac that all was covered for my surgery for disability. My surgery could have waited, which I would have done had I known that they would hold up my payment as they had. I filled out all of my paperwork as requested, followed up a week after doing so to give them adequate time to process them. I was told at this time that they would be requesting further information from my surgeon to establish that this was not a pre-existing condition. I completely understood the need to verify so and was not concerned. They also stated at that time that I would be receiving a copy of this request as well, I did not.
After allowing them another week to send out, am my surgeon's office to receive this request; I called my surgeon's office to verify that it was being processed, or would be shortly. They informed me that they had never received such request for additional information. I as well had not received the copy of this request as stated I would. I notified Aflac of this and was told that a request had not in fact gone out when I was told, but rather just the day prior to this phone call. Patiently, I waited again...
Yet again, no request had been received by either myself or my surgeon's office. I called after another five days to yet again allow them sufficient time to process this request. Upon speaking to the Aflac representative I was informed that the request had not gone out on either prior dates specified, but rather had been faxed - on an entirely different date than I had been given previously.
Again the waiting game, I am now at this point three weeks into my disability and have not received a single piece of paper, let alone a check from Aflac. I at this point make an attempt for some assistance and place, not one, but two phone calls to the insurance representative that had sold me the Aflac policies through my work. These two calls were over a three day period. I did not receive a return phone call from this agent.
I then contacted this agent's supervisor who stated she would look into it and get back to me. Meanwhile, my doctor's office was kind enough to fax to Aflac the requested information that they had verbalized to me that they needed. This was done on two different occasions, both showing fax transmittal forms that verified they had been received at the correct number. Of course, Aflac said that they never received this paperwork on either occasion that it had been faxed.
At this point in my very stressful recovery, I am now at six weeks with no check from Aflac and not much hope of seeing one. My doctor's appointment was scheduled for two weeks from that point. I was now forced to go to my surgeon and request that he remove the cast from my arm earlier than expected and practically beg to go back to work. I am extremely fortunate that I as a supervisor have a different workload than that of many other people. He reluctantly agreed with some stipulations.
My first day back was on a Saturday, last day of a pay period. I hadn't been thinking and should never had returned then, Aflac removed their premium from my check off on days work - after taxes and insurance leaving me $14.00!! Not enough for a tank of gas.
I found that on my first day back to work, Aflac cut me a check for one week! Not the remaining five, just one. Upon return to work I let all employees know via email and bulletins what Aflac had done to me. Next thing I know I have the district manager in telling me he will clear up this issue. Apparently, out of the 450 employees; numerous ones chose to cancel or not take out their policies as planned.
Needless to say, I have now been back to work for two weeks and have still not seen another check for the remaining funds owed to me. They of course have removed all of their fees for their insurance. The district manager has told me that they have all of my information and that they will process it within 14 days with a mailing time of 7 days.
So the bottom line is this, I will have received my disability payments five weeks after returning to work. GOOD THING I HAD DISABILITY INSURANCE!!! Words cannot describe my disappointment and sheer amazement at Aflac's irresponsibility. I truly felt a piece of mind when taking out the policy, that I am my children would be covered should something happen. This was so very untrue! Please be a wise consumer and consider this before signing up for this insurance service. I did the right thing and should not have had to suffer through this nightmare!
EL DORADO HILLS, CALIFORNIA -- Every week, sometimes twice a week, another new face representing Aflac comes to waste our time trying to sell us door to door insurance. Each time we ask them not to return. They keep coming, a new person, normally 2, each time. I hate this company now, and by proxy, the people representing them. Each time I get more irritated, and next time I just might put the next solicitor's head through the glass door. If you work for Aflac selling insurance of all things door to door, you should really take a look at your life and be sad about the events that led you to work for Aflac. 1 star and I'm not a customer, nor will I ever be a customer now.
HOUGHTON, MICHIGAN -- No need to get into a long story. The bottom line is, I was lied to and given false information just so they could take my money for 10 years. Now, I need my benefits and they refuse to pay what I am entitled to! They should be investigated for what they are doing to people!!
TOMS RIVER, NEW JERSEY -- Having moved into a new area at the young age of 55 and starting at a new dealership because my previous place closed down, I confronted a fellow worker who was out on disability but had no coverage. It was at that time the Aflac representative appeared in our showroom and after his talk gave us a symbol of your company (the duck). After careful consideration of myself and my family's history of diabetes I decided to give Aflac a try and enrolled in 3 policies. Well needless to say after 2 months in I came down with a rare condition called charcot foot (fractured foot from diabetes).
Having been out for almost a total of 5 months I can honestly say had it not been for the duck and me looking at it every day and of course your great coverage, I might be very close to being in the poor house. Anyone who thinks they don't need any kind of insurance policy to protect themselves in the event life throws you a curve better get themselves A DUCK and take a long hard look at it and yourself. AFLAC AFLAC I can now return back to work with peace of mind.
WASHINGTON, DC, DISTRICT OF COLUMBIA -- I'm a member for 4 years and knew I had to get dental work done. My insurance took care of my gum surgery and I was informed by my dentist that AFLAC is a waste of money. He asked me if AFLAC Dental was helpful for me. I told him, "No. In fact, trying to cancel is harder than joining." AFLAC dental is a joke! Who pays for a dentist out of pocket?
COLUMBUS, GEORGIA -- 3 years ago I took out 2 Aflac policies. After never using them I decided not to renew the policies. I checked w/ my representative, & filled out the forms she provided me with, signed, had my employer sign, date the request & turn it into the agency. I was assured it was taken care of. The next month my employer received a chastising notice from Aflac about being late with the payment - which he did not owe since the policies were cancelled. The representative claimed they never received a request to cancel. I faxed in the original request & was again assured it would be handled n a timely manner.
The next month, the same thing happened. This time I spoke to a "manager" who was insulting, condescending and just plain rude. She advised me that a "proper signed request" was never received, even though I had a copy of it in my hand. I faxed it over yet again and filed a complaint w/ the Better Business Bureau. A couple of weeks later I received a call from the manager stating both policies were cancelled. I received a letter stating both policies were cancelled & how sorry they were about the way I had been treated.
The next week I received an unsigned letter from the "client services department" threatening me, my coworkers, & my employer with "unfortunate IRS tax situations" if I try to cancel my policy again - they have decided it was in my best interest to "reinstate" my policy?!?! What do you have to do to get a policy cancelled? This is ridiculous! I have properly filled out & signed every single form they have given me. I & my employer have repeatedly requested a cancellation and they reply to these requests with threats of financial ruin?!?!
COLUMBUS, GEORGIA -- As an agent for almost ten years, there are two problems here. One is individuals not understanding their initial waiting periods. To solve this I created a label that I put on the front of my brochures that states Effective date plus 30 day wait = This date for new diagnosis. Pre Existing wait is either six months or one year depending on the plan. This is on all plans that have sickness benefits. The accident plan does not have a wait and the Dental has a different type of waiting period.
I explain to my clients that if you go to a Dr before the 30 day wait and they test for symptoms, even if those test results come back after your waiting period is up, you were still tested for a new condition prior and it will be denied. I do not tell people not to go to the doctor, I tell them they are not covered until after the 30 day wait or pre ex wait.
And the problem with pended claims is pretty simple to fix also. AFLAC requires a basic claim form with your information, and a release form. Then you need to provide proof of treatment for your situation. It is cut and dry and one trip to the hospital Medical Records Dept will yield the needed papers.
A hospital overnight stay requires an Itemized Hospital Bill, an MRI requires an MRI report, a surgery requires the surgery report, etc. AND ALL CLAIMS NEED TO INCLUDE THE DISCHARGE SUMMARY REPORT WITH DIAGNOSIS CODE. Otherwise, you have to get a Dr's signature to verify the diagnosis. This form is available from Medical Records. This means the ONLY form that now must have a Dr's signature is your Short Term Disability form.
Most pended claims are because of insufficient information. HIPPA regulations require you to obtain this info for faster claims processing. If you were hospitalized and have surgery, please submit an itemized hospital bill, surgery report and the Discharge Summary Report with diagnosis code and the claim form and release form and you will find your claim will be quickly paid.
AFLAC also has an claims appeals board that I have had approval through for those unusual situations. Finally, remember your Health Insurance company does not pay YOU cash. AFLAC does and my clients are very happy with their AFLAC experience because I stress the effective dates when they purchase. I hope this post helps someone to know how to file their claims now.
PORTLAND, OREGON -- I am 66 yrs of age, and never before felt compelled to enter any type of complaint. That cute little duck represents the largest ripoff company known to man. My deceased wife purchased a cancer policy two years prior to her diagnosis of colon cancer.
Everyone 'thinks' they have good insurance -- until they have a claim. If you are contemplating buying an Aflac policy (God forbid) before buying, pretend you have a claim -- and call the so called 'claim hotline.' You will get a recording (eventually) -- and they will send you a form to submit. During my wife's illness -- we submitted 54 claims. NONE repeat None were honored in a routine manner.
Typically you will receive a form 'requesting more information'. Then they will request an explanation from your doctor. To further 'discourage' the policy holder -- they break down the claims -- (less than $200). EACH separate claim must have course be reviewed by your physician. Just what a harried doctor wishes to do -- file 8 pages (average) -- SO understandably these forms tend to get buried in the 'IN FILE'. AFLAC IS WELL AWARE OF THIS -- and will go to any length -- stall -- more information required -- anything but honor claim.
I REPEAT we filed 54 claims -- not ONE was handled routinely. MY wife had many chemo treatments. These typically cost about 3-5 thousand each. If you take the time to read the 'very small print -- you will see that several chemicals are excluded from your policy. The bottom line, when you file for your claim -- you will discover that your 'insurance' is good for an average of $250 on each treatment. In the meantime, the insured and their loved ones are becoming 'stressed out' -- Aflac is obviously aware of this -- and the more paper work the better.
Finally, I WENT TO OUR STATE INSURANCE COMMISSIONER and we did eventually receive about $4,000 dollars. All my loved ones expenses totaled over $500,000. We were fortunate to have EXCELLENT PRIMARY INSURANCE -- so we were able to 'weather the storm' better than most.
I WISH THIS RIP-OFF FIRM WOULD SUE ME FOR SLANDER -- I would much like to 'speak my piece' in a public forum. I INCLUDE MY real e-mail -- If any of you need a witness, or statement verification -- pls. so indicate -- I will, at my expense, travel to testify.
I have had an AFLAC Accident policy with a sickness rider since 1998, and except for the $60.00 per year for my physical I have never made a claim on it. That was, until now. I had surgery in August, and then again in December. I was told by the agent that sold me the policy that they wouldn't cover my claim because I'm a teacher, and I had the procedure during the summer.
Then the reps came to school during open enrollment period and I explained my situation, plus the fact that I'd be having surgery again in a month. They "called the company," who said that I'd be covered for both, and told me they'd e-mail me the proper form. It was not the correct form, after I had the doctor fill it out (x2).
I called the customer service number and they told me what form I needed. I had to go back to the doctor and have them fill the new ones out. I called the representative and told him that I had had enough of AFLAC and I wanted to cancel it (I've certainly paid enough over the years) and he sent me a cancellation form. I called customer service just to be sure that was the right paperwork this time, and they told me my company would suffer tax consequences if I cancelled now. He never told me that.
While I realize this may sound confusing to read, it has been even more confusing to experience! One mess-up after another. The message on the customer service line tells you to go to AFLACNY.com for online information. There is no AFLACNY.com... you go to the main site. The rep's name on my page when I finally do get logged on is incorrect. The errors just go on and on. I'm sorry, but come November, I'm finished with AFLAC. I'm lucky I have patient office staff at the doctor's office!!!