how to file accident aflac claim - insurance...

HOW TO FILE ACCIDENT AFLAC CLAIM

Welcome to Summit Insurance Services! We are here to help you and your family during this stressful time. Our services to you are at no cost to you or your employer. In an effort to help expedite your claim we ask for your help in the following:

Step 1:

Please complete the attached “Accident Claim Form” and follow the check list guidelines below.

Have the patient or policy holder complete and sign & 2 Sign the Claim Authorization form Sign Summit authorization form if necessary sign specialty care (St. John’s) Police report (if a motor vehicle accident) Death Certificate (if patient is deceased due to accident)

Step 2:We at Summit Insurance understand that injuries can lead to difficult times, again we are here to help. Please obtain and forward to us copies of the following items as you obtain them to expedite your claim.

Gather and submit copies of the following: (as applicable) Initial visit to physician, ER, or Urgent Care’s encounter notes and detailed billing In-patient hospital bill showing dates admitted and room type Operative report (if surgery needed to correct injury) Follow-up visits (detailed billing) CT, MRI or EEG reports and billing(for policies issued after June 2006) Physical Therapy Appliance (crutches, wheelchair, leg brace etc) Prosthesis Ambulance Transportation & Lodging (if patient was hospitalized more than 100 miles from home)

Contact us at: 307-733-2055 or 800-261-7612Email: [email protected]: 307-733-6178

AFLAC Customer Service Phone: 800-992-3522

HOW TO FILE AN AFLAC DISABILITY CLAIM


Please complete the attached “Disability Claim Form” and follow the check list guidelines below.

Initial/First Claim for Disability

Have the patient complete and sign page 1 Have the employer complete and sign page 2 Have your physician complete and sign page 3 & 4 Have the patient sign the Authorization form

If you are self-employed, send a copy of your current business license and most recent quarterly tax records.

Continuing/Second and Subsequent Disability Claims

Have the patient complete and sign page 1 Have your physician complete and sign page 2 Have your employer complete and sign page 3



HOW TO FILE AN AFLAC CANCER CLAIM


Step1:

Please complete the attached “Cancer Claim Form” and follow the check list guidelines below:

Have the patient complete and sign page 1 Sign the Aflac Authorization form Sign Summit authorization form if necessary sign specialty care (St. John’s) Pathology report diagnosing cancer. Initial physician notes and detailed billing.

Step 2:

We at Summit Insurance understand that fighting cancer can be a daunting task, again we are here to help. Please try to obtain and forward to us copies of the following items as you receive them to expedite your claim.

Gather and submit copies of the following bills (as applicable) In-patient hospital bill showing dates admitted and room type Operative report Anesthesia Ambulance Chemotherapy Treatment Radiation Treatment Experimental Treatment Stem Cell or Bone Marrow Transplantation Anti-Nausea drugs Immunotherapy Blood and Plasma transfusions during hospital confinement Transportation & Lodging (only if patient is receiving treatment more than 50 miles from

home) Extended-Care Facility, Home Health Care or Nursing Services Prosthesis



HOW TO FILE AN AFLAC HOSPITAL CLAIM

Form is used to file claims for the following AFLAC policies:

Hospital Protection: In-patient Confinement, Out-patient Surgery, Invasive diagnostic exams

Hospital Intensive Care: In-patient intensive care confinement, ambulance, organ transplant

Personal Sickness: In-patient Confinement, major diagnostic exam, surgery


Please complete the attached “Sickness Claim Form” and follow the check list guidelines below:

Have the policy holder complete claim form Sign the Authorization form

Gather and submit copies of the following detailed bills and accompanying DR. notes (as applicable)

In-patient hospital bill showing dates admitted and room type Operative report Invasive diagnostic exams (colonoscopy, sigmoidoscopy, arthroscopy etc) Dr Visit

We can be reached at 307-733-2055 or 800-261-7612Email: [email protected]: 307-733-6178


HOW TO FILE AN AFLAC CLAIM

Specified Health Event Claims

Please complete the attached “Accident Claim Form” and follow the check list guidelines below.

Have the patient complete and sign page 1 Have your physician complete and sign page 2 & 3 Sign the Authorization form

Gather and submit copies of the following bills (as applicable) In-patient hospital bill showing dates admitted and room type Ambulance Continuing Care Transportation & Lodging (only if patient is receiving treatment more than 50 miles from

home)

HOW TO FILE AN AFLAC CLAIM

Dental Claims

All dental claims will need to be submitted on the attached American Dental Association (ADA) claim form.

Have the provider fill out the ADA claim form Sign the Authorization

IMPORTANT! If you want the payment to come directly to you, please be sure that box 37 is blank. If you sign in this box or if the dentist puts “signature on file” then payment will be issued to the dentist.

At Summit Insurance we are dedicated to ensuring that your AFLAC claim goes as smoothly as possible. As your AFLAC agents, we are here to answer your questions and help you with the more complicated issues. We can be reached at 307-733-2055 or 800-261-7612

In an effort to assist you in submitting your AFLAC claims for the fastest response, we have included:

□ Claim Form□ Fax Cover Sheet□ Authorization Form

For faster service fax your claims to 877-442-3522


how to file accident aflac claim - insurance...

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