Does aflac cover???

angel1975 · October 16, 2008

I have supplemental insurance through aflac. My primary insurance excludes WLS. I called aflac to see if they would approve wls surgery. It is not excluded in my policy unless it is elective or cosmetic (aflac). I told the rep that my dr. said it would be medically necessary. I wanted to know how I would go about filing a claim to get approval or denial for surgery. She said that I would have to have surgery first, then they would review my case to see if it was covered. ??!! HUH that doesn't make sense. Why can't you review my medical records and go by my dr.'s referral. I asked her if I had to have life threating illness, diabetes, overweight by 100 lbs or more or bmi over 40. She said that there is nothing to go by. You have to have surgery and then we will review your case. How could you not be given approval or denial before surgery. So, I would have to self pay then submit my claim to aflac and see if they pay! Has anyone been approved by aflac??

:wink2:

kgloverii · October 16, 2008

I am not aware of AFLAC having any policies that are medical insurance. You do not get approval for anything via AFLAC, you are always paid after the fact based on what circumstances you have. You may get paid some money for time off work, or something, but I am not aware of AFLAC covering surgeries like medical surgeries.

angel1975 · October 17, 2008

I am not aware of AFLAC having any policies that are medical insurance. You do not get approval for anything via AFLAC, you are always paid after the fact based on what circumstances you have. You may get paid some money for time off work, or something, but I am not aware of AFLAC covering surgeries like medical surgeries.

yes, aflac does cover surgery. I have a sickness/hospital indemnity policy. However, for the surgery to be paid it has to be a sickness. It will cover surgery unless it is elective or cosmetic. The rep could not define what "sickness" you have to have to be covered for wls. If wls is medically necessary then I don't see why it wouldn't be covered. But, my problem is that they will not give approval or denial for surgery costs until after surgery. I just don't understand why. I am not looking to get paid for time off work as I have enough vacation and sick time to take leave. I also have short term disability insurance through them. I know they will pay me if it is covered, but that's not what I'm looking for. I'm wanting to know why they can't give approval or explanation of "sickness" as it is relating to weight loss.

Edited October 17, 2008 by angel1975

kgloverii · October 17, 2008

Just so we are clear, they pay for the fact you HAD surgery, if it is considered covered by them, but they do NOT pay for the surgery. They pay you a set amount for the time you are out of work (if short term disability) and an amount if you are admitted to the hospital, as well as for each full day you are in the hospital. Lapband is considered an outpatient procedure, so I don't think they'd pay you for time spent in the hospital. HTH.

The actual cost of the surgery will have to be paid for by you. Most providers require payment upfront.