AFLAC has the worst claims department I have ever dealt with and I am a licensed claims adjustor Ripoff Columbus Georgia
OK, before I go into this, let me just say, I am a licensed claims adjustor in Michigan and several other states so I know a little more than the average person about the claims process so I knew what may be involved in getting a claim paid but what I have been through is ridiculous.
This began on March 1st for me. I went to the emergency room March 1st with horrible abdominal pain. I was released and set up for an ultrasound. That evening, I went back to the emergency room still in horrible pain and was admitted to the hospital. I ended up having gallstones and having my gall bladder removed. I had recently signed up for AFLAC so it was not until about my 3rd day in the hospital that I even remembered I had the coverage but once I did remember was relieved. I ended up having a 5 day hospital stay because I had to be opened up and was not able to have the quick and easy surgery that is normal these days. Also from having the surgery the old fashioned way it required I be off from work for a month. Also, I had complications during surgey which required even more care. During the surgery, I was burnt somehow and received a third degree burn which required a skin graft. That is another story on its own. OK, so after I was out of the hospital for a week, I got all of the needed paperwork off line and brought one to my doctor to fill out, one to my employer and I filled mine out. I sent it all in and waited as I assumed they would request further info since I had just recently signed up. Sure enough, on March 24th, I got a copy of a letter saying they were requesting records from my family doctor to determine if this was a per existing condition since I had just signed up. No problem at all.
The problem began when I called my doctor about 3 days later to make sure they had also received the request and they said no they had not received it. I figured it had just not arrived yet and I would give it a few more days. About 5 days later, I called my doctor back and they still had not received my paperwork. I hung up with them and called AFLAC. When I finally got a hold of someone after going through one of the most frustrating automated systems I have ever seen, I asked the girl to verify what address the papers were sent to. She gave me the hospitals address where I was treated. I told her no wonder they had not received them, my doctor was in a deifferent town and had nothing to do with the hospital. (this is where I have a problem with AFLAC's forms, they ask for the name of referring physician and no address or any other info and then mail all of the paperwork to the wrong place and then just let the customer wait and do the investigation of what is wrong) The girl then asked me if I had the fax number so they could fax the info to them. I did not have that only the address. At this point, I asked her what type of follow up AFLAC does when they request extra info on a claim. She said if they had not gotten my paperwork in a month or two (yes she said a month or two) they would have sent out another letter. So yeah, another letter would have went to the wrong address.
At this point I asked her to let me speak with my adjustor. Makes sense huh? I have a claim, I should have an adjustor to speak with. Now comes the second problem I have with AFLAC, the girl tells me that the auditors (that is what they are called with AFLAC, not adjustors) do not speak with anyone and that the CSRs give them messages through email. So, that explains a lot of the confusion on this paperwork going to the wrong address because had someone made a call before mailing this out to just anywhere, the confusion would not have happened. So, to avoid any other confusion, I call my office back and get their fax number then call AFLAC back and give it to the girl so she can fax the request. I called my office the next day to verify they received it and they did so you would think things would be set for them to get the info they requested right? No that would be too easy so now, we go to phase two of the nightmare claim..
I waited about a week, we are now talking April 10 to call the office and make sure my records were sent out and run into another issue. My office tells me they bill AFLAC and have to receive payment before they release my records. So, I again call AFLAC and speak to a CSR who tells me they have not received a bill and she still shows they are waiting on my records to complete the claim. I asked her for the fax number for AFLAC so the office could fax them a copy and the girl says they need the original. I call my office back and verify the address the bill was sent and they verified the correct address for AFLAC. On Thursday the 13th, I was getting really frustrated because at this point, AFLAC had my claim for over a month and I was no further to getting it handled then I was on day 1. I called the office for my records on this day for them to tell me they still had not received payment. I called AFLAC back and they told me they had yet to receive the bill. Finally, I called the office back and paid them to get my records sent. I paid almost $75 to get these records on their way and called AFLAC to make them aware of that.
I waited 4 mailing days to call back AFLAC and checked out my claim on the automated system to hear no change in status. I am getting livid at this point. I was off from work for 6 weeks, no pay, and am dealing with a claim where I have no direct contact person and everything seems to be getting lost or not received. (How convienent) I also called them and became so frustrated, I asked to speak to a supervisor. I was on hold for FIFTEEN minutes and the girl came back on twice to ask me if I wanted to keep holding. I finally hung up and sent them an email. Later that day, I got a call from a very nice guy and I called him back. When I spoke with him, I explained to him the situation and lo and behold as we were talking, he received my paperwork from my doctor. He told me he was sending an email to short term disability and hospital indemnity and letting them know they had my records and would scan them in and they would review them. That was a week ago, and I am still getting the same message that they are waiting on the report from my doctor to complete my claim. I sent them another email to ask them what the deal was and they responded back to give them some more time. Today is April 25th, they got my claim March 13th, I am frustrated and sick of dealing with this mediocrity of their claims department. I will be filing a complaint with the state insurance comission when this is all said and done.
I have made it clear to them that I have no problem with them asking for more info on my claim, I understand how this works but if they had a better system and actually called and spoke with people, I would have not had any of these issues. AFLAC needs to take a look at the way they deal with the claims they need more info on and make some major changes in the way they do things. I dealt with this on top of just having major gall bladder surgery and a skin graft and frankly I am just tired and want some resolution.
Cindy
Caledonia, Michigan
U.S.A.
10 Updates & Rebuttals
Florida Mermaid
USAAFLAC CLAIMS-for the future
#11UPDATE Employee
Mon, August 01, 2011
Everyone has done a really good job with information about filing a claim. I have been with AFLAC as an agent 10 years and I try to give my clients a basic understanding of how a claim is paid quickly. Just like when you pay a bill, they need to see proof of services.
AFLAC has different plans, for Accident or for Sickness or for being out of work (Disability). AFLAC will pay you for the different categories but you have to submit proof of treatment and diagnosis codes. Much the same as your health insurance pays. It is a misunderstanding to think all you have to do is fill out an online or paper form (with the exception of some Wellness and Dr visits.)
If you are hospitalized, provide the "UB form" or Itemized Hospital Bill showing admission and discharge dates AND times. This comes from the BILLING Dept.
From Medical Records request a copy of the Discharge Summary with Diagnosis Codes to show WHY you were hospitalized.
If you have surgery, submit your Surgery Report and the Discharge Summary with Diagnosis Codes.
If you have a CT or MRI or Xray, submit your MRI, XRAY or CT report and the Discharge Summary with Diagnosis Codes.
If you have stitches, show how many.
If you need crutches, show documentation or RX.
If you are out of work filing Disability, your doctor and employer must sign off on how long you are out and your income. There always needs to be a first date and a second date for AFLAC to pay you minus the elimination/waiting period.
If you fill out an online form and wait for AFLAC to get the paperwork, you will be waiting a long time. You will get paid usually within 10 days or less if you will get the supporting documentation and fax it to claims at 1-877-442-3522 and ALWAYS put your policy number on it.
You can find a claim form by googling, "Get an AFLAC Claim form" and putting in your state.
If you feel something was denied wrongly, there is an appeals process. But as stated before, that is what your agent is there to help you do.
AFLAC's financial benefits have helped save my clients homes before in certain situations. I have had claims paid that no other insurance company would pay due to special situations that we ask for an exception for. So sorry you had a bad experience. But usually you have to submit the documentation from your medical records and AFLAC works from there to pay you.
And always include a Claims Authorization Release with your claim forms.
Michael - Agent
Glenham,New York,
U.S.A.
What Aflac Policyholders (like yourself) Should Know
#11UPDATE Employee
Sat, July 25, 2009
I agree that your situation was frustrating, and that properly completed paperwork in the hands of the right people is the key to a smooth claims process. You seemed to try to make this as smooth as possible, with limited success.
One thing that I agree with whole-heartedly is that your agent should be part of any claims process that is providing the policyholder resistance. I always offer my services to assist in the claims process. And for the most part, I find that my clients file their own claims with not so much as a peep. I think that's a testament to the simplicity of the process. On occassion, a claim like yours comes along.
After reading it all (including all the rebuttals), the one who walked into your office to offer you your policy should be your first go-to when the problems start coming. If you cannot get in touch with your agent, there's a possibility that person may have moved to a different area, retired or left the organization. Accounts are reassigned as soon as Aflac is notified by the agent that they will no longer be handling the account. The new agent is responsible for approaching the account and introducing themselves. I have inherited many an account and provided years of quality service to those accounts.
If this has not happened and neither you nor your company have been contacted in some time, I suggest you contact Aflac's World Wide Headquarters (the number can be found on your policy, the bill the employer receives or you can go to www.aflac.com or www.aflacny.com) where you can ask for contact information on your agent, or your agent's District Manager (DM). The DM is a field trainer for the agent and should step in to assist when a situation like this arises.
Part of Aflac's allure that I believe puts us at the "front of the pack" is that we offer personalized service. From the first time we walk into a business, we have a "start with an eye-to-eye" and "end with a handshake" approach. Our philosophy is to start that way and continue on with full service to the employer AND the employees bringing a consultative approach to enrollments and a "helping hand" in getting a claim submitted.
Please keep in mind, along with all the agent does, they do NOT make determinations on claims in any way, shape or form. I personally, do not even make the determination of whether a claim is valid. If my policyholder believes that they have a claim, I will review their policy with them, and if after that, they believe that they still have a claim, I will assist them in getting it in to Aflac's Claims department. That is where claims processing, determination of validity and payout happen....not with the agent.
Other than being another voice trying to get your records for you from the doctor, I doubt that your agent could have done a great deal more than what you had already done for yourself. It's just nice sometimes to know that you have someone there to help if you need it. As an adjuster, you are probably acutely aware that insurance is "piece of mind". If nothing else, let me tell you that there are thousands of Aflac agents out there, and I know a few of them personally who provide top notch service to their people. I would like to think that what happened to you is the exception and not the rule when it comes to Aflac quality.
As far as cancelling your policy and signing a new one...here in my state (NY) your policy would have to have been inactive for six months, otherwise it goes right back to the original agent. The new writing agent doesn't even get paid for reinstating you. So, you would have to decide if you want to forego coverage and run the risk of illness/injury during your downtime, or just maintaining coverage. The idea of reporting the situation to the DM will most likely get it fixed for you, and from my experience, that seems to be what most people want...not revenge, just what they feel that they deserve...what they signed on for....what they're paying for. I do too.
Lastly, I would just like to note for the record that every Aflac agent is an independent agent and cannot speak on behalf of Aflac or Aflac-NY. Therfore, the aforementioned is all my personal opinions and insights and neither Aflac nor Aflac-NY had any input into this suggestion. It is meant to be viewed as an opinion / suggestion and represents the independent views of only myself in order to help or assist readers in getting the most of their experiences with Aflac / Aflac-NY and their independent agents.
Hope this helps.
Brandy
Phenix City,Alabama,
U.S.A.
I agree with you Donna
#11Consumer Suggestion
Sat, September 02, 2006
Aflac's claim dept. is set up with contact between the auditors and the customer service department due to the fact that if you had individual contact with that auditor, it would make the processing times significantly longer than they already are. Another thing you have to remember is that when you mail something to Aflac in GA, it doesnt just appear in the mailbox there when you drop it in the mail on your end. The postal system determines that and they give Aflac a 7-10 business day time period, not only for your mail to get to them, but also for their mail to get to you.
Aflac is a place of business like any other and because of some legal aspects involved in paying a claim, it should be comforting that the claims department is careful in review and processing of your claims documents.
FYI: The claim forms ask for the Physician's Name, Adress, Phone and Fax numbers so if the information was sent to the hospital and not the physician, the address was either left blank on the claim form or the address provided was incorrect from the start.
Sorry that you had that experience, but your agent should have been involved in the process. They are the ones who would act as your "claims adjuster" as far as you contacting someone directly.
Donna
San Diego,California,
U.S.A.
AFLAC has the worst claims department ever
#11UPDATE Employee
Wed, August 30, 2006
Dear Cindy,
I work for Aflac in California, and I wish I had seen this when you were going through this, because I would have helped you. I don't know where the ball was dropped, certainly your agent should have been involved, but even without your agent's involvement I have to say AFLAC is the best company I've ever done business with. That's why I left my last job and went to work for them. They are fast with their turnaround times, the joy of dealing with them in Columbia is the fact that they're not off kilter like most representatives in major cities, they have the hospitality thing going on.
In your position I'm not sure what I would have done, because actually we are the easy company to deal with. The fact that this was a hassle, is incongruent with all of my experiences with AFLAC. But I can tell in your frustration I can hear it in your words that your complaint is valid.
Tracy has some good ideas; If you don't have a business card for your Representative then your HR person should have a list with all AFLAC contacts - either you or your HR representative should go up the list and see where the breakdown was. To be fair, if your Rep never knew the extent of what was happening, call them in and have a sit down. If you feel escalation is in order, do it. I can say with the certainty of anything I've ever done before that AFLAC doesn't reneg on it's promises, there's no bait and switch, and although the bulk of people don't believe it, we really want to help you!
Katie
Las Vegas,Nevada,
U.S.A.
Agent
#11UPDATE EX-employee responds
Sat, August 05, 2006
Cindy, I really don't think you should feel the way you do about your policy and everything. If I were you, I would cut off my policy (as long as you will be the exact same rates) and resign with a different agent or call AFLAC directly and tell them you want a new agent. If you do cut off your policy and resign it, that agent will no longer get residual income from you. It might make him rethink his customer service. Anyway, I hope that from here on out everything goes well for you.
Katie
Las Vegas,Nevada,
U.S.A.
Agent
#11UPDATE EX-employee responds
Sat, August 05, 2006
Cindy, I really don't think you should feel the way you do about your policy and everything. If I were you, I would cut off my policy (as long as you will be the exact same rates) and resign with a different agent or call AFLAC directly and tell them you want a new agent. If you do cut off your policy and resign it, that agent will no longer get residual income from you. It might make him rethink his customer service. Anyway, I hope that from here on out everything goes well for you.
Katie
Las Vegas,Nevada,
U.S.A.
Agent
#11UPDATE EX-employee responds
Sat, August 05, 2006
Cindy, I really don't think you should feel the way you do about your policy and everything. If I were you, I would cut off my policy (as long as you will be the exact same rates) and resign with a different agent or call AFLAC directly and tell them you want a new agent. If you do cut off your policy and resign it, that agent will no longer get residual income from you. It might make him rethink his customer service. Anyway, I hope that from here on out everything goes well for you.
Katie
Las Vegas,Nevada,
U.S.A.
Agent
#11UPDATE EX-employee responds
Sat, August 05, 2006
Cindy, I really don't think you should feel the way you do about your policy and everything. If I were you, I would cut off my policy (as long as you will be the exact same rates) and resign with a different agent or call AFLAC directly and tell them you want a new agent. If you do cut off your policy and resign it, that agent will no longer get residual income from you. It might make him rethink his customer service. Anyway, I hope that from here on out everything goes well for you.
Cindy
Caledonia,Michigan,
U.S.A.
Thanx Katie
#11Author of original report
Fri, July 21, 2006
Thanks Katie for your thoughts. After all of the hassle, I finally got my claim settled and paid. I thought the nightmare was over. A week later, I get a letter that they had rescinded my policy back to the effective dat. So, the newest chapter began. I filed a secong complaint with the insurance commission and went from there. Finally, after another 5 weeks of fightning with them about this and no one being able to help me when I called in, ect... They reinstated my policy and apologized saying it was a mistake by a customer service rep in the company..
My agent was NO help at all!!! I tried contacting him and he would not get involved at all. I now have my policy but do not feel like I have an agent I can count on and that is sad. I only hope should I ever have to use my policy again that things go a lot smoother. When you are having to use your AFLAC policy you are not feeling like being on the phone fighting with people for what you should be getting anyway!
Thanks again!
Katie
Las Vegas,Nevada,
U.S.A.
Where was your agent?
#11UPDATE EX-employee responds
Fri, July 21, 2006
I completely understand your frustration; however, just out of curiosity, where was your agent when all of this was going on? Your agent should have been handling this.
I worked for AFLAC for two years and I filed claims myself. I didn't make the policyholders do the claims because it is a service that AFLAC provides. The agent is to do the enrollments, servicing, and claims, etc.
AFLAC does have a terrible wait time, I will agree with you on that. I do think that your agent should have been there with you making these phone calls though. It's disappointing to see someone hate the company so much when a few people could have done their jobs better....