Complaint Review: Aflac - Columbus Georgia

I am NOT an employee of Aflac, but I AM an independent insurance agent, and I've been selling Aflac products (as well as Blue Cross, and some others) for over a decade.

First off, Aflac is NOT 'Accident Insurance.'  Yes, there is an Accident Policy, but it is only one of 14 different products that the company offers (depending on what state you reside in.)  Aflac also sells Cancer Insurance, Specified Health Event, Vision Care, Dental, Life Insurance, Hospital Indemnity, etc, etc.

You claim that the amounts paid on the Accident plan are 'not worth the postage.'  Really?  The Accident plan in my state pays $120 for the inital visit after an injury (remember now, this is NOT health insurance, and is not intended to cover the cost of the visit...your major medical takes care of that..this is merely extra money for you to help with any out of pocket costs you may have.  To be honest, the company doesn't care what you do with the extra money.) 

Okay, so there is the $120...then the six follow up visits after that ($35 each; total of $210), then the TEN physical threrapy visits per injury ($35 each; total of $350), plus $200 for a CT scan or MRI, $125 if you needed crutches, $200 if an ambulance was involved...and I'm not even getting into the Specific Sum Injury Benefits.  If you break a bone, Aflac pays a benefit depending on the size and location of the fracture.  (A recent claimant who I assisted received $900 for a spiral fracture of her ankle.  The $900 was JUST for the fracture.)

If you are admitted to the hospital because of an injury, the amounts are even bigger.  I had a client who fell while working on a telephone line.   He spent 6 days in the hospital (multiple fractures).  The hospital stay ALONE paid $1000 for the first night and then $250 a day every day after that, until he was released. 

You mention that Aflac needs to know how an injury occurs.  Is that really so difficult? Why would you NOT be able to document HOW the injury happened?  Aflac doesn't requre that the doctor or medical provider be PRESENT during your injury, only that you state to them how it occurred and that this is included in the treatment report.

I'm sorry you have experienced difficulty getting your claims paid.  Are you asking your agent (or any agent, for that matter?) to assist you?  If you have a legitimate claim, and were unsuccessful in getting it paid, I urge you to contact the State Sales Coordinator in your area and request assistance.    And please, if you are going to go naming agents by their first and last name in a derogatory manner, (which I would advise you against doing in the future; there are 2 sides to every story.) then at least have the courage to post your OWN full name.

Again, I am not an employee of Aflac; only an independent agent who likes and sells their products.   In my tenure as an independent agent, I have seen many, many large claims paid, and families and individuals who would have been in catastrophic financial situation if they didn't have the extra money Aflac provided. 

I wish you only luck in the future. 

At one time Aflac was a reputable business. Claims were paid quickly with a minimum of paperwork. Now, however they are only concerned with maximizing profits and minimizing expenses. Remember Aflac is ACCIDENT insurance. The last claims that I filed were rejected because the doctor could not state that the injury was definitely an accident. When I asked the doctor, he stated that that has always been the way they do reports, and they could not state the definite cause of an injury, since they did not witness it.

Just how many people are going to break their limbs on purpose? How many people can only have accidents in the presence of their doctor? This is a loophole scam that Aflac is exploiting to boost its profits in a bad economy.

Calls to the local rep (Missoula MT in my case) go unanswered and unreturned, Information left with the receptionist is mysteriously lost. Calls to the reps cell phone are also unanswered and messages are unreturned. Call the national office and they are routinely dropped. (I read a story about this phenomenon: If the calls are on hold too long, the call center staff gets punished, But the computer tracking software credits an answered call, even if it is hung up immediately)

Missoula representative Carla Fluery is completely incompetent in her job. Always at the company benefits seminars, touting the wonderful benefits of Aflac, trying to get new customers, but never answering direct questions about difficulty of getting claims paid. Never returns call or is at her office. Aflacs actual payouts are so minimal, that even if they were fully paid, rarely are they worth the cost of the policy.

For the several years that I had Aflac, I filed for every accident: broken bones, torn ligaments, sprains, cuts as well as the standard annual wellness payment. All for an accident-prone family. When I totaled the entire benefit, I would have been better putting the monthly premium in a coffee can. It seems that postage alone for resubmitting claims costs more that the payment.

Look elsewhere, or just save some money in a rainy day fund.

I don't know what has happened to this company, but from my side of the fence, this is corporate healthcare maximizing profits as the expense of the little guy. How could an individual possibly have the resources to sue a company like this over a few hundred dollars?

How long have you been selling Aflac products, Steve?  Your assertion that claims is 'constantly behind and slow' is simply untrue.

I not an Aflac employee, but I do sell some of their products as an independent sales associate, and I can tell you first hand that Aflac claims is the quickest I have ever seen (and I've sold for several other companies, including their competitors.)

Last week I had a claim paid in 48 hours.  I would suggest, Steve, that you educate your policyholders at the time of application, as to what they need to do IF they are injured or get sick (depends on which policy(ies) they are buying.)

One more comment:  I'm very impressed that an Aflac manager stepped up to the plate to offer help to the original poster. 

I appreciate what Garrett is saying and offered. That is the way it should be. I am an independant agent representing Aflac products. I love their stuff. I like to sell it. The claims system is constantly behind and slow. I never tell a prospective client about the 4 day claim process. I have never seen it. Even on my own simple claim of a broken tooth. I got paid within 3 weeks, and I submitted everything correctly.

I wish Aflac would move away from that 4-day claims paid claim.

Michelle: I can tell you as an representative of Aflac, you've got it all wrong. The previous rebuttal employee is a Regional Coordinator with Aflac, who has absolutely nothing to do with and is not responsible for your claim. Yet, while most people who weren't involved would stay miles away from an upset customer such as yourself, he is willing to help you in any way he can - including posting his phone number on this website! How's THAT for customer service? This response from Aflac representatives is more the norm, far more typical than the poor customer service you apparently received. BRAVO, Garrett! If there is a delay in processing a claim, it's because it takes far longer to process and pay a claim than it does to deny one. Aflac pays far more in claims that anyone in the industry. I know that the good people at Aflac headquarters are doing their best to live up to the "four days". If you ever have a problem in the future, you can call your agent, or his/her coordinator. This info is available by calling customer service (which will call you back if your wait is longer than 3 or 4 minutes). Good luck, Michelle! Pete District Sales Coordinator Long Island, NY

Michelle: First, I would like to apologize for the service that you received from our call center. Unfortunately, when you have a company with thousands of employees this can happen. However, it does not excuse this behavior. I also want to apologize for the miss information. The best way to handle a claim is to work directly with your agent. This information can be provided by the company that your husband works. It can also be obtained directly from our main office. I am a regional manager with Aflac. I have been with the company for over 8 years. I started in the field as a sales associate and I have worked my way to regional manager. I have hundreds of policyholders and accounts. I have personally filed hundreds of claims for people just like you and your husband. I can tell you that Aflac does work, and many times claims are paid within 3 days. The average is a week. The average for our competition is 3-4 weeks. I strongly feel that your situation happened due in part by our call center and in part due to miss information. I completely understand your situation and I would like to offer my assistance. I will be happy to help you resolve this matter. My office is located in Cranston and I live in Warwick. If need be I will meet with you in person and at a time that works for you to resolve this. My office number is 401.461.3010 and my email is [email protected] Please contact me and let me help!