Transcription of New Claim Form PDFs for WEB - S2029
{{id}} {{{paragraph}}}
Example: biology
New Claim Form PDFs for WEB - S2029
Of Claim decision:Date of Claim decision is the date listed on your denial letter or Explanation of Benefits of loss:American Family Life Assurance Company of Columbus (Aflac) ATTN: Claims Appeals PO Box 84065 Columbus, GA 31908 For information or to check Claim status, visit Appeals may be faxed to 1-888 659-1023 Page 1 of 3 HC0021 06/19 Claim APPEAL FORM Today's Date: Thank you for trusting Aflac with your supplemental insurance needs. The appeal must be filed within 180 days of a claims decision. You may file up to 3 appeals per Claim . Please provide documentation from your health care provider to support this appeal. If you have additional bills ormedical documentation that relate to this diagnosis, please submit it along with this form.
For information or to check claim status, visit aflac.com. Appeals may be faxed to 1-888 659 -1023 . Page 3 of 3 . HC0021 06/19 DUCK *If your Aflac policy is subject to ERISA, the following review process applies: If a claim for benefits payment under the policy
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: