REDDING, CALIFORNIA -- I purchased AFLAC specifically for orthodontic supplemental coverage for my son. I was told I would pay into this for one year and at that time would be eligible for braces for my son. I was told this by my representative Mark ** in the Redding area. After we had X-rays done and a consult, the dentist office states we aren't eligible because I hadn't paid into it for two years. Now I'm on the hook for X-rays and consult visit. I was completely lied to. To top it off, the representative doesn't return calls and has essentially disappeared.
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!!
In my experience there is no way to fill out a claim form that meets their standards. Every Claim I have sent has ended up with them claiming that the information was not correct. They ask for my doctor's information, and additional information related to my claim. After many phone calls to find out why the claim was not paid customer service will promise to look into it and then they will never call you back. If you are persistent they will tell you to start again. I have accident, cancer and insurance to cover heart attack.
LEVITTOWN, PENNSYLVANIA -- Very frustrated about what information to submit??? I have Invasive Metaplastic Breast Cancer. I have had a mastectomy, reconstruction surgery has begun, home nurse visits, I will be getting chemo. What do I submit for the hospital, surgery, anesthesiologist, plastic surgeon, surgeon? I don't know what to submit but they sure know how to turn down a claim for not submitting proper paperwork. WHAT DO YOU WANT FOR EACH SUBMISSION AFLAC?
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?
SACRAMENTO, CALIFORNIA -- They said my pre-existing disability is not covered. I was told by the agent I was covered but now they say I was denied. This is crazy so they was just taking money out my check and I just deal with. I really need an attorney to look into this scam as company. I don't care if you're Fortune 500 company. They are scamming lying cover ups. I hate Aflac and hope the company crumbles.
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.