Why American Fidelity Assurance Company Sucks

When the representative from your offices came to W----- T-------- to sign up employees, I listened to the lecture, read the pamphlets, and discussed the benefits packages with my husband. I signed up for the plan and began seeing the cost taken almost immediately from my paycheck, but I was not considered "covered" by the policy until one month later.

Within two weeks of coverage, my husband began to feel poorly and was rushed to the hospital with acute stomach pain. The pain was so intense it cause a heart attack, which I could only watch, helpless and afraid. He was hospitalized for several days and when he was well enough, he came home. He was not permitted to work for another week following, but I assured him all would be well. After all, I said, we have hospital coverage.

The bills did not stop because my husband nearly died. Our child did not require less feeding, gas did not become suddenly less expensive, and laundry machines, since we do not own our own home, were not magically free of charge. Quite simply, my single disrupted paycheck did not cover as much as two continuous paychecks. But I continually assured my husband that all would be well. After all, I said, we have hospital coverage.

I decided to be pro-active about the claim and called to find out what I would need. The message that played while I waited promised that American Fidelity was protecting America's paychecks. I was told that all of his medical records during the stay would be required, as well as a written diagnosis of each charge on the itemized invoice. I had my husband, who at this point had only been back to work a matter of days, take an afternoon off so that he could get the medical records and the invoice. Sadly, I did not write down the name of the person who gave me this erroneous information.

The invoice itself was not ready for two additional weeks. As for his records, those were easy to get. I called my health insurance company and was told they would not provide an explanation of benefits. I called American Fidelity Assurance Company back to ask about the diagnosis sheets and described the paperwork. The next woman I spoke to, again I did not get a name, said I did not need all of that. I was told all I needed was the itemized bill and my claims form. I had those items so I submitted the paperwork.

I faxed the original paperwork at 11:20am EST on 9/7/07. I called back on 9/13/07 to make sure it had been received and was being processed, and was told it had not been received. The message that played while I waited still promised that American Fidelity was protecting America's paychecks. I faxed it again at 4:06pm EST that same day. This time, I was not leaving anything to chance. I called the very next day to make sure it had been received and was told it had been and was being processed, please allow 7-10 business days.

As of 9/14 I was due to make a second car payment, my lights were about to be shut off, the phones were about to be cut off, the cable was going to be suspended, and I had to scramble to make ends meet. I explained the situation and most companies were understanding. Because I had never been made aware of any "investigation process" I assured them I would be able to take care of things by the end of September. When I called on 9/27/07 to confirm that my claim had been processed and a check was going to be issued, I was informed that I needed to submit additional documents. I was shocked and disappointed. I asked that the forms for my husband to fill out be fazed, and I was told that was not the proper procedure. I had to wait for them to arrive by mail. Frustrated into tears, I hung up.

When the forms arrived, they contained several release forms and something called a PHP sheet requesting the names, addresses, phone numbers, and dates of service for every medical professional my husband has seen in the past year. We filled out the forms and I faxed the "PHP" the next day, 10/4/07 at 12:24pm EST. I called a sixth time and discussed these papers. The message that played while I waited promised that American Fidelity was protecting America's paychecks. I wanted to cry because I was not being protected, I felt jerked around. I offered to get all of the medical records and was told I was not allowed to do that. That is what the release forms were for. I called each hospital to check on the status of my request to send the medical records to American Fidelity.

When I called last week, on 10/5/07 I was assured the "PHP" had been received. Surprisingly, the pharmacy I had listed had sent in their records already. For the first time in months, I felt hope. Unfortunately, that lasted until I got home and found a late notice from the rental office on my door and disconnect notices galore in my mailbox.

I called today, 10/9/07 and was shocked to learn from Janis that the PHP had not actually been received. I was also told that I had gone about the claims process the wrong way. I questioned her, trying to find out why so many people had told me so many different things. What I got instead of an explanation was a repetition of the forms needed and a polite reminder that I did not need to fill these forms, but I wouldn't be getting my money. She said she would look into it and call me back. By the end of the day I had not heard anything so I called.

I was repeatedly interrupted and when I asked, almost begging, to just be heard, her response was icy and unsympathetic. She finally stopped cutting me off long enough to let me speak, but she kept repeating the litany of paperwork instead of addressing the real issue I was having, which was why had I been told so many different things?

I asked for a supervisor, who was no less robotic and unfeeling. She repeatedly avoided all attempts to discuss my frustration about being told different things during each of my eight calls, and finally she said "Well I show here you have only called three times, and there are notes about the conversations." I hung up on her, in tears.

I am disappointed in the lack of customer service, the complete failure of communication, and the unfortunate lapse in information that seems to be shared by the nine people I spoke with, despite there only being a record of less calls. I am not paying American Fidelity to call me a liar, I am paying them to help me in my time of need. If I had known this process would be so arduous, time consuming, and emotionally painful, I would have passed.