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Aflac / aflac doesn't want to pay!

1 United States Review updated:

I took out an AFLAC Intensve Care policy in March 06. The effective date of coverage was April 1, 2006. I actually took the policy because my mother had coverage and it was a wonderful help when she had cancer. In Oct 06, my husband had a heart attack and was in the hospital for 9 days. According to the policy, we are due a per day reimbursement the sub-acute room (8 days),reimbursement for the ambulance and for one day of intensive care. I faxed the claim on Nov. 10. Every single day I am told the claim will be processed that day & they have everything needed for the claim. I can't tell you how many times they have requested new documentation, a couple of times they've asked for the same info twice. Half the time, they deny receiving the paperwork, even though I have the fax confirmation sheet. I always re-fax immediately. I was told AFLAC had a 5-7 day turn around. We are over three weeks now. I have asked every day this week to speak with a supervisor, only to be given reasons why I can't. Reasons range from "I'm in management" to "We don't have per se supervisors" to "I will talk to you and relay your concerns to the appropriate person". Today when I told the customer service rep that this delay was unacceptable, I was told that it was considered "suspicious" that I took out the policy in March and now my husband has Coronary Heart Disease. She said heart disease does not have a sudden onset and he "must have rec'd prior treatment". When I asked if it would help for the primary doctor to send a statement to them attesting to the truthfulness of the claim, I was told that the auditors would really consider that suspicious if I started sending in unsolicited documentation. It was also implied that I have called too frequently this week!!! Hmm, perhaps that could be because my husband has been out of work for 7 weeks now and will not be released to return for several more? I should add that all of the agents are very friendly and polite. A couple of them have offered to call me back if there are more requests for documentation. Of course, none of them have actually done so. I have to call the next day to find out what the new paperwork is for the day.
It is unethical for a company to solicite business, offer coverage, acccept premiums, then when a claim is made, to imply to the policy holder that they are considered to be a liar and a cheat because a claim was made too soon in AFALC's opinion. Even though the hospitalization occured 7 1/2 months after the effective date of coverage.

Va
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Comments

  • Wi
      26th of Jan, 2007
    0 Votes

    I'm going through the same thing. I informed them of "prior" conditions and my "agent" said no worries. I have a witness and I was smart enough to record my conversations with my agent. I live in Tennessee and prior to purchasing the policy was very open about my "pre-existing" conditions and even showed the "agent" my medication. He put in the policy on his "laptop" no pre-existing conditions. I could not see what he put into his lap top but was told to sign this "pad" after he finished typing. I thought everything was kosher and now they are saying "Oh, you had a pre-existing" condition which could nullify your policy.

    Well, that set me off real quick. I told her "the lady on the phone" that I informed him of my "pre-existing" conditions and she said it was not noted in the policy I signed. So I explained the lap top deal but I did not tell her I had a witness and recored my agent.

    I'll let you know how the AFLAC people treat me and believe me. I'll spread it all over planet earth with proof of how they get premiums and don't pay. I call that a scam.

  • Al
      13th of Apr, 2007
    0 Votes

    It always amazes me how individuals blame the company for an "agent" caused issue. Did you know that all agents are 1099 self-employed for Aflac. You'll probably find that this agent will be investigated by Aflac and probably terminated if the investigation supports your facts that is. Blame the agent, not the company.

  • Sh
      1st of Dec, 2007
    0 Votes

    I have a issue because I want to end my Aflac due to Financial hardship. I was told that I could not do that. Which means the money will continue to come out of my check every to weeks. I was told by Aflac and my job to just pick up more hours to help myself. I can not drop to Aflac until enrollment which is not until September of 2008. I don't understand why if I can no longer afford something, why do I have to keep it.

  • Ma
      17th of Jan, 2008
    +1 Votes

    okay...let me start at the top:
    1. when you ask for a manager they give you a manager, 2. they do state that you did fraud or that they are suspicious about your claim, 3. i have called on one of my claims everyday for a whole week and they treated me just a nice with respect as when i called the first time to file my claim. 4. i have intensive care it does not pay for ambulance (the hosp pol does) if it states on their that it will pay a sub acute room, the itemized hospital bill needs to say
    your husband was in a sub acute and it needs to say how many days and when he was transfered from the intensive care to the sub acute. 5. depending when the claim was received, what day they are processing, is when you will receive your benefit. they do process hundreds of claims a day-research hundreds a day-and if you dont submit all your documentation...how do you expect for them to process your claim any faster. i am sorry for you and your husband...but dont blame the company...you need to blame where its do and its the person filing the claim but not submitting everything...oh on the fax...it they are receiving hundreds of faxes a day and your fax happens to transmit at the same time that your does...do you think it will go thru...no!
    okay...now to the agent one:
    before you sign anything you need to read it...they show you the application and ask you is everything okay...before you sign it...if you saw false information you should have not signed it...also if you knew you had a pre existing condition why would you sign up for an insurance...there are no medical insurances that will pay on a condition that is pre existing...or how about when you received the policy...you should have read the clause and then called in and said...i want to cancel...before it became effective...
    so now it brings me to financial hardship:
    i have been there and done that...but you know there is a law by the IRS that states that no changes nor cancellations can be made until open enrollement of any company even your own personal insurance...i was in your position...i wanted to cancel one of my policies due to harship at one point...but you know what...i knew that i was on a cafeteria plan with my company and that no changes nor cancellations could be made till open enrollement and i was only in the company at that time for 3 mths....How long have you worked at yours???
    i am not trying to be uglyl...i am just trying to prove a point that people just like putting blame on something else other than putting the blames on themselves...
    the only one that made was Alex..how did he know that i dont know but it sure sounds right to me...if you have a complain about your agent complain to your agent not the customer service reps who are trying to help you...thank you.

  • Ma
      17th of Jan, 2008
    0 Votes

    sorry correction...i got all carried away...aflac representative will never judge you on lying or trying to cheat the company...so line 2. they do state that you did fraud or that they are suspicious about your claim is they DO NOT!!!!
    another type error...was on the only one that made was Alex....he was the ONLY ONE that made SENSE!!
    thank you!!

  • Ib
      7th of Apr, 2009
    0 Votes

    I have 3 aflac policies. Two outside of work deductions, and 1 short term disability that is via payroll deduction.
    i have had the two oudside of work for about 3 years...and the short term for 1year and 4 months.
    I had major surgery...4 weeks ago. Waited the mandated one week wait. Submitted the claim via agent. i called her on day 7 of the wait she told me would max take 10...just to see if there was a problem. And she said oh did you get the letter. no ...no i didnt until yesterday...which was yes you guessed it requesting more info...which was faxed over to them ASAP and followed p with a call..and on and on. i will be back to work next week. I may or maynot have my claim paid. BUT...i did ask them to stop the automatic bank draft for my non employer related policies...and they did and will send me a bill. Which if i dont pay will CANCEL my policy. Thank goodness
    I am a single mom of two. I was told The policy would help for a short term disability. I didnt go to the ER and have a bandaid placed on my pinky finger for an owie...and now im upset because i cant get 100 bucks out of them. Disability is a disability...i cant work...work wont let me back until Dr. signs a form. Aflac hasnt paid. my son really likes to eat! im broke...AFLAC is the devil.

  • Pm
      8th of Apr, 2009
    -1 Votes

    quit ur pussying they pay and well if ur not stupid know how to file it idiot

  • Nu
      1st of May, 2009
    0 Votes

    My complaint is I have a sickness diablitity short term policy with AFLAC since 2000. I was diagnosed in 2004 with Espstein Bar and CMV and have been out on my policy a few different times, once I have even filed a continuation and it was paid and it wasn't after the 180 days and it was the same or related condition.
    Now AFLAC is adding words to the Policy I purchased with them and telling me that I need to be released from my Dr before I can submit another claim. If that's the case then why would I receive a letter stating _Your short term Disability policy, In part 1, under Definitions, Letter N. Successive Periods of Disability it states, "benefits for disability caused by sickness or off the job injury which causes your continuing inability to perform the material and substantial duties separate period of Disability, if the Disability is caused by the SAME or RELATED condition and not separated by 180 days or more, are considered a CONTINUATION of the prior disability. So how can your Dr release you if it's the sane or related condition. Sounds misleading to me. I guess I need to dig a little deeper and ask for help from someone who knows the law better then I do. If you h ave a contract with someone you can't add anything to it after you feel that your not making out on the deal, it's not legal?? My new condtion is a related one and AFLAC will get both a new claim and a continuing disbility one on the 180 th day. And I'll go from there.

  • Lu
      23rd of Sep, 2009
    0 Votes
    Aflac Insurance - Slow response on the job applications
    LHJAssociates.com
    United States
    lhjassociates.com

    Total disrespect thru the entire 3 interviews, never called back on time, never followed up with me and only pay thru PAYPAL so they can easily put an immediate hold on all your money immediately. Stay away...OR Good Luck!!

  • Ki
      21st of Aug, 2010
    0 Votes

    Aflac is TERRIBLE. I purchased supplemental dental insurance through my employer with Aflac. It went into effect April 1, 2010. The end of August I was going to have dental work done, and I got the "dental codes" from my dental provider. I called Aflac, and told the person I was going in a couple weeks to have these procedures done, and I needed to know what would be covered, and what would be my portion. She gave me all the information. I started to have my procedures done, and when the dental provider submitted the claims, they paid NOTHING. It went back and forth, and then I was told there was a six month waiting period, which would be October 1st before anything was covered. Had I known that, I certainly would have scheduled my appointment for after that. Nobody EVER said anything about that when I called. I gave all of my info, and was not told that EVER. I've gone back and forth with them, and all I keep hearing is the six month waiting period was not adhered to. I could possibly understand if I had just gone and had the procedures done and then questioned, but I called FIRST and went by what they told me. So I've been paying my premiums all this time and they have paid NOTHING. Unbelievable!! They have AWFFUL customer service, and poor customer relations.

  • Kk
      14th of May, 2012
    0 Votes

    My husband has AFLAC AT WORK ON A FAMILY plan for critical illness. Now on the policy it states that it will pay for cancer, I, his wife have cancer, I sent everything in an they will not pay. So the first thing I will do is find out from the company my husband works for is how and when AFLAC was contracted and let my husband's company know that the Company that they contracted will not pay.The there is the insurance commisioner, who I will also get ahold of. AFLAC HERE i COME SO YA BETTER PAY UP, CAUSE I DON'T BELIEVE IN GIVING MY MONEY TO INSURANCE AND NOT RECEIVING ANYTHING FROM THEM WHEN i HAVE PAID AND I AM ILL!!!1

  • Fr
      6th of May, 2018
    0 Votes

    Why is AFLAC long term care so popular in Japan?

  • Ki
      15th of Aug, 2018
    0 Votes
    Aflac - Accident policy claim
    United States

    Aflac auditors are refusing to pay my claim. I have been submitting the SAME information since day one for any claim that I file and all of a sudden the information is not valid. They've processed every other claim with the information that I've obtained from my provider, which is the same information that was submitted. I need answers!!!

  • Af
      22nd of Oct, 2018
    0 Votes

    @Kie Riggs Hi Kie Riggs,
    I'm Aflac Phyllis, an Aflac worldwide headquarters employee here to help. I would like for our Contact Center to look into your concerns.

    Please ask your wife to email us at aflacservice@aflac.com so we can assist her with her concerns. When you email us, please include the following in the subject line of your email: Aflacdeadbeat https://www.complaintsboard.com October 22, 2018.

    Aflac policyholders should provide at least two of the following: Address, Claim number, Claim Check number, Date of Birth, or Name of Employer.
    Thank you,
    Aflac Phyllis

  • Sh
      15th of Aug, 2018
    0 Votes
    Aflac - lack of coverage
    tulsa, ok
    United States

    my wife was denied all coverage, and she was dropped after her cancer consultation, with her cancer policy...after her cancer surgery her short term disability was denied after missing work for 8 weeks

  • Af
      22nd of Oct, 2018
    0 Votes

    @shey lessley Hi,
    I'm Aflac Phyllis, an Aflac worldwide headquarters employee here to help. I would like for our Contact Center to look into your concerns.

    Please ask your wife to email us at aflacservice@aflac.com so we can assist her with her concerns. When you email us, please include the following in the subject line of your email: Aflac-Lackof coverage https://www.complaintsboard.com August 15, 2018.

    Aflac policyholders should provide at least two of the following: Address, Claim number, Claim Check number, Date of Birth, or Name of Employer.
    Thank you,
    Aflac Phyllis

  • Af
      20th of Aug, 2018
    0 Votes
    Aflac - Service and agent
    Taunton
    Massachusetts
    United States

    Have filed a claim smart claim 3weeks ago. Got hit by a car during work and broke back and leg
    Still waiting. No money. The agent did absolutely nothing. Victoria barek

    Liars is what they are. Gonna file a suit. False advertising

  • Af
      22nd of Oct, 2018
    0 Votes

    @Aflacdeadbeat Hi Aflacdeadbeat,
    I'm Aflac Phyllis, an Aflac worldwide headquarters employee here to help. I would like for our Contact Center to look into your concerns.

    Please email us at aflacservice@aflac.com so we can assist you with your concerns. When you email us, please include the following in the subject line of your email: Aflacdeadbeat https://www.complaintsboard.com October 22, 2018.

    Aflac policyholders should provide at least two of the following: Address, Claim number, Claim Check number, Date of Birth, or Name of Employer.
    Thank you,
    Aflac Phyllis

  • Ga
      20th of Aug, 2018
    0 Votes
    Aflac - Insurance
    Columbus
    Georgia
    United States

    I submitted a claim to aflac for being in the hospital and they won't pay the admission benef bec they say it has already been paid which is not true. I was in the hospital for something different than before and they're saying its the same condition but it's not. They always try to deny my claims.

  • Af
      22nd of Oct, 2018
    0 Votes

    @Gabrielle Sherman Hi Gabrielle, I'm Aflac Phyllis, an Aflac worldwide headquarters employee here to help. I would like for our Contact Center to look into your concerns.

    Please email us at aflacservice@aflac.com so we can assist you with your concerns. When you email us, please include the following in the subject line of your email: Gabrielle Sherman https://www.complaintsboard.com August 20, 2018.

    Aflac policyholders should provide at least two of the following: Address, Claim number, Claim Check number, Date of Birth, or Name of Employer.
    Thank you,
    Aflac Phyllis

  • Mi
      19th of Sep, 2018
    0 Votes
    Aflac - disability check that im missing
    United States

    Aflac needs to get their [censored] together and the representatives all to be on the same page its a constant [censored] show dealing with this company...this is my second claim that i have had issues with...they are very negligent with customer paperwork

  • Sc
      4th of Nov, 2018
    0 Votes
    Aflac, Inc - short term disability - insurance agent MISREPRESENTS claims to get customer to sign up
    Pasadena, ca
    United States
    Aflac.com

    Aflac agent tells my wife who just found out pregnancy with home test agent tells wife to sign up for insurance and that she would be paid & others have been paid as long as she hasn't gone to DR yet. when claim was filed, agent tells wife sorry must be covered for 10 months. agent lied to get wife to signup & get commission! need to find lawyer

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