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I was admitted to the hospital by my doctor for high blood pressure and stayed over night. I submitted all the necessary paperwork to Aflac and my claim was denied!

The reason they gave was that the plan did not cover ER or outpatient treatment. WHAT???? Mine was neither! I never set foot in the ER, and it was not for outpatient treatment...I was admitted!

I made sure I had provided a detailed description as well as I included all the paperwork from the hospital. Did they not read it?!

Do they automatically deny claims? What a scam!

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Guest

To Taja:

You need to make sure your doctor gives details of complication. If he or she did not give details on the claim form or any documentation that is why it got pended or denied. They just need additional information to be able to review for complications.

All you need to do is get a letter from your doctor, on their company letterhead and signed by the doctor explaining details of complications and fax down to 1-87*-***-**** ATTN: Claims dept for review.

Make sure you reference your Policy# on the cover sheet and or claim number from your Initial disability claim.

(If you don't have claim number you may contact AFLAC at

1-80*-***-**** and get that claim #.

Guest

To the policyholder that was hospitalized for high blood pressure.....

AFLAC offers about 10 different policies based on the individuals needs. Depending on the type of policy(s)you took out that will determine if benefits are do under that particular policy you took.

Example: If you have the AFLAC Accident policy and you were hospitalized for High blood pressure, which is considered illness not accident/injury then your policy will not pay benefits for that stay being it was not accident or injury related.

On the same respect if you have an accident or injury and you have a hospital policy for illness only then that would not pay.

Again, AFLAC offers choices based on your personal and family needs. Hence, the different types of coverages offered.

You may want to check with AFLAC to see exactly which policies you have and you may want to re-evaluate on the type of policy you took out.

Guest

Just because you stayed overnight at the hospital does not mean you were an acute inpatient. Chances are you were admitted to OBSERVATION which is an outpatient level of care.

AflacPhyllis

Hi,

I'm Aflac Phyllis, an Aflac worldwide headquarters employee here to help. Please email your contact information to us at aflacservice@aflac.com so we can assist you immediately.

Thank you

Shubh Rjm
reply icon Replying to comment of AflacPhyllis

Hahahahahahahahahaha!!!! Right.

Guest
reply icon Replying to comment of AflacPhyllis

Hi Phyllis, I am an Aflac customer. I recently submitted a claim on the 12th for maternity benefits which was a continuing claim because I was put on maternity leave early because of complications.

My claim was denied. All of the paperwork was sent.

I'm not sure why the claim was denied. Can you give me a clue?

Guest

Look at your bill. Based on what you've described it sounds like the information sent in does not indicate hospital confinement.

I've seen it millions of times.

The information sent in needs to show the diagnosis and inpatient room charges. If you can't get the inpatient room charges then the next thing would be a discharge summary showing the exact date and time of admission and discharge.

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