I took out an AFLAC Intensve Care policy in March 06. The effective date of coverage was April 1. 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.
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