Just like everyone else I too am a VICTIM! I signed up through my employer. Aflac comes once a year and ASSURES you all you do is submit the claims and your covered. I have had the accident policy for 5 yrs, and signed up for hospital this year. Keep in mind that I have Never received any information via mail from Aflac regarding my policies. I always called with questions I had. Recently, I filed two claims. After NUMEROUS CALLS I WAS assured don't worry your covered just submit the forms back in we're mailing you. I had two hospital stays, and surgery. I called to make sure my hospital policy was active, & my claims would be paid before I submitted these claims.
Each and every time I was told that yes the policy was active and to submit my claims. Good customer service is to tell me EVERYTHING I NEED TO KNOW WHEN I'VE NEVER SUBMITTED OR USED MY POLICIES. ESPECIALLY WHEN YOU ASK ARE YOU SURE I Can submit these claims on several calls to these people! So, I did but I still called. I called from the hospital, and home. One claim they said they needed mdo office notes. Keep in mind I was admitted on 06/25, and I called AFSLAC ON 06/24 I told SEVERAL reps that I was admitted to the hospital from the er, and filed the claim on 07/22 which was held up until 8/30 due to office notes needed & that the er doc won't have any office notes.
Then they said well do you have a PCP I said yes well if they saw you for the condition we can use that. Now, they said they mailed my pcp a letter to request the info. So, why did the letter come to my home? The outside of the envelope had my name on the envelope but the letter was addressed to my pcp??? So, I asked my mdo to fax me the copy of the initial visit because they charge a fee to fx the insurance company. When I called to verify if AFSLAC GOT MY FAX THEY Said yes the auditor has it, and we can use that info for both claims Ms Moore. My second claim was submitted on 8/15 & held until 08/30 as well pending office notes. Here's where the BS STARTS!
I called the automated system on today 8/31 it says claim was denied! I ask for customer service and was told that my claim was denied because I was within the 30 day waiting period! I said I know your calls are recorded and I know that somehow calls are tracked! I noted I have been calling in since 06/24 to make sure these claims were coverable and as a company that provides CUSTOMER SERVICE TO YOUR CONSUMERS DON'T you think that making sure your consumers are thoroughly educated on the service you provide? I asked if the rep knew about the waiting period? Ha ha she said YES!!! Why wouldn't you inform your customers? Okay, she agreed yes ma'am. She gave me a sup, I asked him the same question! I said we're going to role play. You call me because you have life insurance.
You have a concern on the suicide clause because your wife is mentally unstable (I worked in customer service 10 years and I told me customers about any and all changes I knew about on their medical coverage no matter what!). You call my company 20 times within a month asking if suicide is covered? We say yes sir it is. You were phased out of your job (me), you got the policy through the job before you were phased out, received NOTHING about the policy via mail etc. You're taking our word suicide is payable and covered! Your wife kills herself. You call in several times to collect on the claim I say send us the Death certificate and autopsy notes. I hold your claim for 45 days, you call back in I say it's denied! You ask What do you mean denied?
I say yeah DENIED BECAUSE THERE IS a 2 year suicide clause!!! How do you react??? His a* held that phone scrambling for a response!!! Oh, then he says let me get the booklets on your policies sent! I ask for what? Your going to cancel ALL MY POLICIES TODAY. I'm getting ready to fax my request now! All this back and forth calling and faxing from 6/24-8/29 and I was not even pass the grace period of 30 days! When you call you would think that a part of a companies customer service training is EDUCATION! The company I worked for WROTE YOU UP FOR NOT EDUCATING CUSTOMERS Because if they don't know it was my job to educate them! Hope no one he knows has life insurance, supplemental, medical, or any type of insurance that gets screwed out their money! I hope I gave him something to think ABOUT!!!
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