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.
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