How to File an Aflac Claim Online
Whether you have the hospital, accident, or the critical illness plan, you’ll need to file claims with Aflac. As a note, we are always happy to help you file Aflac claims, all you need to do is email [email protected] or call 888-315-8027. But if you want to file the claim on your own this guide will walk you through it!
Step 0: Register for an Aflac Account
Before you can file your claim online, you’ll need to register your account. Luckily this is pretty easy. All you need to do is head to www.aflac.com/login and click “register.”
You’ll need to use your certification number to file as we do not provide your sensitive information to Aflac directly. You can find your certification number on the policy letter we sent to you. If you don’t have that number saved, we can send it to you, please request it by calling 888-315-8027, or by emailing [email protected].
As a note, your certificate number needs to be ten digits so you might need to add some 0’s before your username. For example, if your certificate number is 25400-1234, your login 0000001234.
If you need additional support for creating an account head to https://www.aflac.com/individuals/myaflac/getting-started-guide.aspx
Step 1: Beginning your Claim
Aflac offers multiple ways to file, you can do a paper file, an online file, or file through the app. We recommend you file online through this site: www.MyAflac.Aflac.com. This is the easiest way to file and walks you through the process step by step. The app is also very useful, and you can find it by searching “MyAflac” in both the Google Play and Apple app store. But since you’ll need to attach supporting forms and documents from your doctor, it might be easier to do it on your computer.
If you want to paper file, you definitely can! But you will either need a fax machine or a scanner. We put together the steps to file by paper at the end of this article since it involves different steps.
Once you are on MyAflac’s site click “New Claim” on the left hand side. If you have multiple Aflac plans, you will then have to select which plan you’ll be using. Click the correct plan and then hit next in the bottom right corner.
You will then be asked if this claim is covered under wellness or is part of your bigger plan. Wellness claims are things like routine tests or doctor visits, for a full list of what counts as a wellness claim, click here.
Once you’ve chosen Wellness or Accident/Critical Illness/Hospital, click next.
You’ll then be taken to a page that contains all of the documents you’ll need to file your claim. Note that the ones under “required” are always needed, you might need additional documents which are explained in the drop-down menus on the lower half of this page. This is the most time intensive part of the process (it’s also where we can help the most!).
Step 2: Collecting your Information
If you need help finding different forms, check the final section of this document, where we lay out all the different forms and the best ways to get them. Just note that different hospitals and doctors have different procedures. Also, different events might require further documentation, such as a police report or notes from your doctor.
We recommend checking to see if your doctor/hospital has an online portal with your forms before calling as it can usually be a lot quicker. If you can’t find the information you need online, or if that is too much of a hassle, you can certainly call their office and tell them what forms you need. You can also let them know it’s for an Aflac claim and they might know offhand which forms and files you need (it really depends on the doctor though).
Additionally, you might have to sign a release to get a lot of these forms sent to you. Because of that, you might have to go to the doctor’s office to get this information.
If you are having trouble finding any documents, we can help! Send us an email explaining what claim you’re filing and what documents you need and we’ll help.
Additionally, you will need your insurance information, information about when you were treated/diagnosed, and information about where you were treated (your doctor’s name, phone number, and address).
Step 3: Finishing your Claim
Now that you have all the documents you need. You’ll be able to finish filing your claim. Head back to MyAflac’s site or the app and begin filing. If you closed the claim window, you will need to begin again.
Select the right coverage type, choose if it is a wellness claim or not, and then follow the instructions. Input the information about yourself, your insurance, and the doctor. Once you’ve finished that. You will be asked to explain what you’re filing the claim for in a small text box. Be sure to state clearly what happened and the timeline of events. If you were injured, explain how, if you received treatment, explain what!
After that, you’ll be able to sign a HIPPA compliance form and then upload your forms.
From there you can choose to be paid by direct deposit or paper check! Direct deposit is faster, but this is obviously up to you.
You’ll then be taken to a page that allows you to review your claim and then submit! Once you’ve submitted your claim it may take 48 hours to show up on your MyAflac page, but after 2 days you can check the status by clicking the “My Claims” button on the app or on the site.
After that you’re done! Again, if you have any trouble feel free to reach out to us. We know it’s complicated! But we’re here to help.
Call 888-315-8027 or email [email protected]
Paper Filing Step 1: Find your Claims Form
To start your claim, you’ll need to head to this site and find the right form for you. You can also click from the list below:
Each claims form differs greatly, so we will do our best to point out any important things to note as we go through, just know that they seem a lot more complicated than they actually are. The hardest part is just finding all the necessary documents.
At this point, we recommend you start filling in your claims form. There will be some questions that ask you to include documentation, we recommend you make a note of what they’re asking you to include. If there are some questions you’re unable to answer, email SDPEBA and we will do our best to help.
Tip: Keep a notepad where you can write down all the forms and documents that Aflac requires as you fill out your claims form. That way you know exactly what you’ll need to submit alongside your claims form.
Paper Filing Step 2: Collect your Information
Aflac has a handy set of PDFs that help walk you through what kind of documents you’ll need to submit your claim that you can find by clicking here: https://www.aflac.com/individuals/policyholders/claims-checklist.aspx
Be sure you’re looking at the Accident Claims Checklist, Critical Illness Claims Checklist, or the Hospital Claims Checklist, as these are the only plans SDPEBA offers through Aflac.
If you need help finding different forms, check the final section of this document, where we lay out all the different forms and the best ways to get them. Just note that different hospitals and doctors have different procedures. Also, different events might require further documentation, such as a police report or notes from your doctor.
We recommend checking to see if your doctor/hospital has an online portal with your forms before calling as it can usually be a lot quicker. If you can’t find the information you need online, or if that is too much of a hassle, you can certainly call their office and tell them what forms you need. You can also let them know it’s for an Aflac claim and they might know offhand which forms and files you need (it really depends on the doctor though).
Additionally, you might have to sign a release to get a lot of these forms sent to you. Because of that, you might have to go to the doctor’s office to get this information.
If you are having trouble finding any documents, we can help! Send us an email explaining what claim you’re filing and what documents you need and we’ll help.
Paper Filing Step 3: Send your Claim in
In order to send your claim in you can either email your forms to [email protected] or fax it to 1-866-849-2970. If you are filing through the website or the app it should take the form directly, just make sure you’re following the steps carefully!
Tip: If you’re emailing your files in or uploading them to the app, make sure you name your documents! For example, if you’re sending in a pathology report, save your document as Last Name Pathology Report. It’ll help you stay organized and could help get your claim filed faster.
Finding your Forms
Finding forms is one of the hardest parts of filing a claim. We put together this quick guide to help you find information quickly. Just a note that we can always help you find forms. So, if you’re having any trouble, contact SDPEBA!
Commonly Needed Phone Numbers
Sharp Hospitals: 858-541-5400
Sharp Rees-Stealy: 858-262-6422
Palomar - 833.631.0069
Kaiser - 800.498.2748
Rady's - 858.966.4912 or [email protected]
Scripps - 877.727.4777
Sharp Health Care - 858.499.2400
Sharp Rees-Stealy - 858.499.2410
UCSD - 855.827.3633
Who to Call for Medical Records
Rady's Medical Record Department: 858-966-5904
California Orthopedic Institute: 619-291-8930
Concentra - CIOX Customer Service (Concentra's 3rd party Medical Record Processing Company): 1-800-367-1500
Balboa Naval Hospital's Medical Records Division: 619-532-9344
Palomar Hospital Medical Records: 760-480-7911
Palomar Health Medical Group ROI Department: 858-675-3199
Scripps' ROI Department: 760-633-7746
UCSD ROI Department: 619-543-6704 and select option 5
Sharp Rees Stealy's ROI Department: 858-262-6422 & [email protected]
Sharp Hospital: 858-541-5400
Sharecare (Sharp's 3rd party Medical Record Processing Company): 800-560-3800
As a reminder, sometimes you will need to sign a medical release in order to get certain information. These forms often need to be faxed or dropped off in person. If you’re having any difficulty getting these forms, please contact SDPEBA. While we cannot guarantee that we have the forms on file, we might be able to help you get one quickly.