Complaints

• Initial Complaint

  07/20/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My complaint is that I have not heard from ANYONE in this company for three months while they are 'working on' my disability claim. I am the one calling them, to no avail, and while I am putting in requests for a phone call, since May 2024, no one from the company has returned my phone calls or requests for a phone call.I have been waiting, since April 26, 2024, for updates and a decision on my disability claim. I have been on leave from work since March 7, 2024, without any income. This company's long winded, and inexplicably LONG review process of a disability claim, for someone out of work and not receiving any income, is neglectful. And I am paying this company a monthly due for coverage. Company has a fiduciary duty to writer, as writer is paying over $90/month to company for disability insurance.Company received writer's disability claim, in full, on or about April 26, 2024.On or about May 26, 2024, Company received requested records from Provider A and an invoice for records from Provider ** It is not known to writer, if or when, company paid Provider B for these records. Company's notes indicate that on June 25, 2024, company notated they needed records for a medical doctor who WORKS for Provider B, not seeming to realize that this medical doctor IS provider ** It was told to writer, that there are no further notes beyond June 25, 2024 for this disability claim. Writer was told that on July 2, 2024, 'some' additional records were received, and that as of July 19, 2024, this claim remained under review for 'preexisting conditions' and has been since May 2024. The time period in which this company, who writer is a CLIENT OF, requires a client to WAIT for a disability claim decision is woefully neglectful, and renders further harm and suffering on this writer.Writer is demanding contact from this company as to the STATUS of the disability claim, and further answer any questions writer may have.

  

  Business response

  07/26/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on July 8, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states she has been disabled since March 2024,
  with no income. Our insured states that since she filed her claim for disability benefits on April
  26, 2024, she has not heard from American Fidelity regarding the status of her claim. She states
  that she has been told her claim is under a pre-existing condition review and medical records
  were being requested. Our insured is wanting a claims decision.
  Based on the information available to us, our insured applied for a Group Disability
  Income Benefits policy on October 12, 2023, with a January 1, 2024 Effective Date. Our records
  indicate that on April 26, 2024, our insured submitted all three required sections of the claim
  form for disability benefits. Based on the information provided on her claim form and due to the
  recent January 1, 2024 Effective Date of coverage, we determined a review of her medical records
  was necessary to rule out Pre-Existing Conditions. On May 7, 2024, we mailed an Explanation of
  Benefits (“EOB”) to our insured advising that a Pre-Existing Condition review was needed and
  requested completion of an authorization form and to provide contact information for her
  healthcare providers. In an EOB mailed to our insured on May 16, 2024, we advised her who we
  submitted medical records request to and asked for her assistance in our efforts of collecting her
  records. By July 9, 2024, all requested medical records were received. In an EOB mailed to our
  insured on July 23, 2024, we advised that no benefits were payable due to the Pre-Existing
  Condition Limitation. Furthermore, our records provide that we have remained in constant
  contact with our insured through our chat feature, phone conversations, and EOBs throughout
  claim review.
  Our goal is for our insureds to have positive experiences with American Fidelity and we
  invite the insured to contact us if she would like to further discuss the situation.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  AMERICAN FIDELITY ASSURANCE COMPANY • 9000 Cameron Parkway Oklahoma City, OK 73114 • americanfidelity.com
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  07/20/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I work for a school district & if you get paid in the summer you get 24 checks a year, if you do not get paid in the summer you get 18 checks a year. I signed up for American *************************** on 24 pays. When I got my first paycheck I noticed ** was taking out more money than they should. I emailed my ******** finally got back to me in February saying they have me on 18 pays not 24 pays and billing will correct this issue. I never heard back from him again. In May, I emailed my rep saying the issue still isnt corrected because ** is still deducting the wrong amount but I asked him to make sure they would not be taking out payments from my 6 summer checks. I never heard back from my rep. I got my 2 summer checks & ** was deducted, I contacted ** rep again and he finally responded saying I thought billing had it corrected. My benefits **** copied me in on emails to another ** rep all they keep saying is billing is working on it and give it time. He wanted me to call him and he told me they were sending me $294, my company was sending me $441 and Texas life (afs life insurance *** was sending me $141. I told him to email me with everything we discussed and in email the numbers were different. I emailed the ** rep showing him that ** owes me $826.99. ** is claiming they owe me $487, I keep asking how hes coming up with his numbers and he refuses to give me a itemized list but just keeps telling me to be patient it takes time. Ive been patient since Feb. New ** rep has been working on it for 7 business days. It shouldnt take that long to figure this out.. He did say they sent me a check on 7/15 for $441 & a check for $46 with no explanation of how they came up with that amount. I want to cancel all of my policies and ** rep said cant cancel when its not open enrollment. All I want is an itemized list of how the ** rep came up with their numbers, to get my correct refund amount and to cancel all of my policies with **. I never want to do business with them again.

  

  Business response

  07/29/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on July 20, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that her employer offers 18 or 24 paycheck
  cycles for employees. She states that she signed up for coverage and is on a 24-paycheck cycle.
  She states that her premiums were being deducted based on an 18-paycheck cycle and not a 24-
  paycheck cycle and she notified us in January of this issue, but the issue has not been corrected.
  She argues we advised she is due a refund of $487.00, but she believes we owe her a refund of
  $826.99. She states she wants to cancel all her coverages, but we advised her that she cannot
  cancel her coverages outside of open enrollment. She is asking for an itemized list of how we
  determined her refund and wants to cancel all her policies.
  Based on our review, it appears that American Fidelity, our insured, and her employer
  worked collaboratively to resolve her billing and refund concerns surrounding her hospital
  indemnity, disability, accident, cancer, and life coverage.
  When our insured completed applications for coverage on December 11, 2023 with
  February 1, 2024 requested Effective Dates, the information we received from her employer was
  that she was paid on an 18 period pay cycle. The Benefit Verification and Deduction form our
  insured electronically signed on December 11, 2023 authorized her employer to deduct each
  policy premium from her earnings for an “18” period deduction cycle.
  Our insured’s employer group does not typically allow benefit changes outside of the
  enrollment period for any benefit plans offered through their employer health and welfare
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  benefit plan. Our records indicate the insured initially called customer service on January 29,
  2024 inquiring about cancellation of her coverage. On February 2, 2024, in line with our standard
  process for cancellation inquiries, the Account Manager emailed our insured and left a voicemail
  requesting to set up a meeting. While she did not return his call or set up a meeting, she did
  respond to his email. He stated that they corresponded back and forth but a definitive decision
  regarding cancellation of coverage was not made.
  In April 2024 our insured filed a claim under her hospital indemnity coverage and in May
  2024 she filed a claim under her disability coverage. Applicable policy benefits were provided for
  each claim.
  After meeting with our insured’s employer on July 26, 2024, a decision was made to allow
  her to cancel all coverages. Her accident, cancer, and life coverage will be cancelled effective
  February 1, 2024 and all premium paid will be refunded. The hospital indemnity and disability
  coverage will be cancelled after the date of the claims for which benefits were provided.
  Accordingly, the hospital indemnity coverage will be cancelled effective April 1, 2024 and the
  disability coverage will be cancelled effective June 1, 2024. All applicable premium received after
  those dates will be refunded. The Billing Department is currently working on cancellation of the
  coverage and refunds will be processed shortly.
  If our insured would like to call and discuss their specific situation in more detail, they can
  contact our Customer Service Department at 800-662-1113.
  Sincerely,
  
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  07/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I elected to enroll in multiple insurances through American Fidelity in August of 2023. I was told that my coverage would begin in October of 2023. At the time I had no known health problems and was signing up because my school district offers this insurance and I decided that I wanted the peace of mind that their company provides. I found out in October that I was going to need a hysterectomy, due to extreme Anemia that was quickly onset and began causing me a lot of symptoms and ***** issues. I was taken off of work because I began needing blood transfusions and had my procedure on November 1st. The last day that I worked prior to be taken off on disability was October 11th, when my doctor took me off of work. During this time, I spoke to American Fidelity 5 times, to ensure that my claim was received, being processed and checked my insurance coverage to ensure that there were no reasons that my claim would not be approved. They assured me each time that everything was fine and that I would be hearing from them soon. I was able to relax during my recovery, having peace of mind that I had disability insurance.I was told by American Fidelity at the end of November that my claim was denied. I was told 3 different reasons, by different people as to why it was denied. The first reason was because it was a preexisting condition, which it was not, and the second being that I did not work 4 consecutive days in October. The third reason written in my denial letter, is that I did not work on October 1st, when my insurance went into effect. However, I did work October 9, 10 and 11. I feel that American Fidelity is using a technicality to not pay me the money that I am entitled to for the time that I was off. I experienced a lot of financial hardship due to their denial of my claim, because I was told by them each time I called, that my claim was being processed and everything was fine with my claim. Therefore, I made no other financial arrangements.

  

  Business response

  07/15/2024

  See attached response.

  The complaint submitted by our insured states that she enrolled into multiple products in August 2023. Our insured states that at time of enrollment, she had no known health problems.However, due to a quick onset of health issues, she was taken off work in October 2023. Our insured states that her claim ended up being denied due to a technicality. Our insured states that she made no other financial arrangements because American Fidelity led her to believe that her claim was being processed.Our records indicate that on August 31, 2023, our insured applied for a group disability policy with an October 1, 2023 Requested Effective Date. The policy documents were issued and/or made available to our insured on September 6, 2023. Our insured began submitting claim documentation for policy benefits on October 30, 2023. Throughout the processing of our insureds claim, the insureds employer advised that our insured was off work from September 20, 2023 October 6, 2023, returned to work October 9 10, 2023, and then remained off work.The policy states, If You are not on Active Employment due to an Accidental Injury or Sickness when Your coverage would otherwise take effect, it will take effect after the date You go back to Active Employment for at least 5 consecutive Regular Days of Required Attendance. As our insured was not on Active Employment on the Requested Effective Date, her policy did not go into effect on October 1, 2023. Because coverage under the Policy did not become effective October 1, 2023, no benefits are due for her October 2023 disability claim. Our records indicate that applicable premiums were refunded and that our insured subsequently purchased new group disability coverage effective May 1, 2024.Our goal is for our insureds to have positive experiences with American Fidelity

• Initial Complaint

  06/24/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I have had MANY years with American Fidelity. I have had disability insurance for years, along with many other forms of insurance. Once I got sick and was written off for FMLA and I have had a horrible time with them. They do not want to assist, They explicitly leave out information so they can deny you. The agent I spoke with stated to me that they mistakenly "conveniently" forgot to send the forms to my physician as I requested. Now several months later I am still dealing with it. I have wasted so much money on these worthless insurances, and I want people to be aware of how shady their business practices are. I have a mortgage and I am single mother who thought she was doing the best thing in case something would happen, but its been a nightmare!

  

  Business response

  06/27/2024

  Please see attached.  Thank you.

  This correspondence is in response to the Better Business Bureau complaint received in
  our office on June 24, 2024, filed by the above referenced complainant.
  
  The complaint submitted by our insured states that she got sick and submitted a claim.
  She argues that we forgot to send forms to her physician as she requested. She states she is a
  single mother, and it has been a nightmare. She wants us to finish the job and contact her
  physician.
  
  Our standard process requires receipt of a complete claim form for benefits and all
  necessary records to determine applicable Policy benefits. On March 12, 2024, we received our
  insureds portion of the claim form. On March 19, 2024, we sent her an Explanation of Benefits
  providing the employer and physician portions of the claim form and requesting she return the
  completed forms. On March 20, 2024, we received **** paperwork from our insured. We spoke
  with her and explained the **** paperwork did not include the necessary information and the
  employer and physician portions of the claim form were required to consider policy benefits. On
  March 26, 2024, we received the employer portion of the claim form. On April 15, 2024, we spoke
  to the physicians office and requested information about our insureds diagnosis and treatment.
  They advised that an executed authorization was needed to provide any information. We spoke
  to our insured on June 3 and 5, 2024 and explained the completed physician form was still
  needed. On June 7, 2024, we received the completed physician form. On June 25, 2024,
  applicable policy benefits were provided to our insured. Based on the information available to us
  it appears that the necessary steps were taken in processing our insureds claim as quickly and
  efficiently as possible while adhering to applicable Policy provisions.
  
  Our goal is for our insureds to have positive experiences with American Fidelity and we
  invite the insured to contact us if she would like to further discuss the situation.
  
  
  
  P.O. ************************************** americanfidelity.com
  
  
  BBB complaint BBB ID NO. ********
  Office of Appeals
  
  
  Sincerely,
  
  
  *******************************
  Office of Appeals
  American Fidelity Assurance Company
  
  
  LDK/ker

• Initial Complaint

  06/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I have been off work since early May. I provided all my documents upon submitting my claim May 14th. My employer resubmitted their statement form May 24th. This is also the day American Fidelity verified my documents were recieved. However, this has been the status since. I had my claim expedited for a 48 hour review May 30th and because the request fell on Thursday, they had until today June 3rd to process and/or update my claim status as I was informed by customer service via phone and chat inquiry from earlier today. As of 9:30 central time, I see no update and my claim is still reflective of the same status of being received. This is one problem that has been consistent with this company; failing to process claims in reasonable and their own cited timeframe of 7 to 10 business days once all documents are recieved. I have a mound of bills adding up, including medical ones and needed my funds released at least by this month. Filing such complaints as this has unfortunately been the only effective way of getting them to truly expedite my claim, as well as understand my frustration with processing times

  

  Business response

  06/10/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on June 4, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that by May 14, 2024, American Fidelity
  had received all required claim forms for benefit consideration. She states that to date, her claim
  has not been processed.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. Based on our review, we received
  all three required sections of our insured’s claim on May 14, 2024 for a disability commencing on
  May 2, 2024. After receipt of our insured’s claim forms, we obtained a signed HIPAA authorization
  form from our insured so that we could request her medical records on her behalf for benefit
  consideration. On June 5, 2024, we received the requested medical records. In an Explanation of
  Benefits mailed to our insured on June 7, 2024, our insured received a disability payment covering
  the period of May 9, 2024 – June 7, 2024, as she satisfied the 7-day Elimination Period May 2-8,
  2024. Our insured can expect her next disability payment to be issued on July 5, 2024. If our
  insured expects her disability to extend beyond August 1, 2024, she will need to submit updated
  claim forms. We did explain to our insured why our processing time is a little longer than our
  standard 7-10 business days, and we processed her claim has quickly and efficiently as possible,
  while adhering to applicable policy provisions.
  We believe this matter to be resolved. However, we invite our insured to contact our
  Customer Service Department at 800-662-1113 if she would like to further discuss the situation.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  AMERICAN FIDELITY ASSURANCE COMPANY • 9000 Cameron Parkway Oklahoma City, OK 73114 • americanfidelity.com
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  06/10/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me, but better correspondence about wait times can help customers understand when his or her claim is prolonged.
  
  Sincerely,
  
  *********************************

• Initial Complaint

  05/21/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  I completed the necessary forms for 3 HSA reimbursements 5-6-24 with a process date of 5-7-24. American Fidelity claims a timeline of 5 to 7 business days. I called last week when deposit was not received and rep informed me of a known issue and to call back today. I called back today. A different rep was aware of the issue, but had no information on a timeline of resolution. American Fidelity is withholding my funds longer than is reasonable and will not even provide information on an expected resolution.

  

  Business response

  05/28/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office after business hours on May 21, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states she has a Health Savings Account (“HSA”)
  with American Fidelity. She states that American Fidelity claims a timeline of 5 to 7 days for
  processing reimbursements, but she made a distribution claim for her HSA on May 6, 2024, and
  the distribution has still not been deposited into her account. She feels American Fidelity is
  withholding her funds longer that is reasonable and will not provide information on an expected
  resolution.
  Unfortunately, American Fidelity did have a technical issue with direct deposits scheduled
  on May 7, 2024. We have traced to the root of the problem and are working diligently to correct
  the issue and complete the direct deposits from May 7, 2024 as quickly as possible. We are sorry
  for any inconvenience this may have caused.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. If our insured has additional
  questions, she can contact our Customer Service Department at 800-662-1113 or the manager
  whose contact information she has.
  Sincerely,
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  05/28/2024

  
  Complaint: ********
  
  I am rejecting this response because: I was not seeking an apology or explanation. I am seeking access to my own money. There is not even a timeline for resolution of the issue. Three weeks is more than sufficient time for American Fidelity to have resolved any technical issues and to have remedied this issue, yet the money remains inaccessible.
  
  Sincerely,
  
  *********************

  

  Business response

  06/03/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint rejection
  received in our office on May 29, 2024, filed by the above refenced complainant regarding our
  May 28, 2024 response to her initial complaint.
  The complaint rejection submitted by our insured states there is not a timeline for a
  resolution of the issue and feels that three weeks or more is sufficient time to resolve a technical
  issue to remedy the issue.
  The issue has been resolved and the HSA distributions have been deposited in our
  insured’s account.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. If our insured has additional
  questions, she can contact our Customer Service Department at 800-662-1113.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  05/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  i bought disability insurance through my job. this policy suppose to pay income benefit in case i got injured and not able to do my job. they were very tricky and they operate in different state so it will be even harder to file a complain through the department of insurance in **********. for a whole year they played around and they were able to get around the system.

  

  Business response

  05/13/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on May 6, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that he bought disability insurance
  through his job which is supposed to provide benefits should he become disabled and unable to
  work. Furthermore, our insured states that American Fidelity operates in a different state which
  makes it difficult for him to file a complaint with the California Department of Insurance.
  Our records indicate that our insured has filed two administrative claim appeals, to which
  we responded to on December 21, 2023 and March 26, 2024, respectively. Our insured’s Policy
  provides Disability Benefits for each period our insured remains Disabled due to a covered
  Disability and under the Regular and Appropriate Care of a Physician which continues beyond the
  Policy’s Elimination Period. In our responses to our insured’s appeals, we explained that based
  on his claim documentation, medical records, and medical reviews, he was not Disabled beyond
  his Policy’s Elimination Period due to the lack of Regular and Appropriate Care for his disabling
  conditions and his medical records and/or Attending Physician Statements did not support
  functional limitations and/or restrictions that rendered him Disabled from his Regular
  Occupation. Therefore, based on the terms of our insured’s Policy, benefits were not payable.
  Also, our insured’s Policy is sitused in Oklahoma. Accordingly, our insured can easily submit an
  insurance complaint with the Oklahoma Insurance Department if that is his desire.
  It is our goal for our insureds to have positive experiences with American Fidelity. We
  invite the insured to contact us if he would like to further discuss the situation.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  AMERICAN FIDELITY ASSURANCE COMPANY • 9000 Cameron Parkway Oklahoma City, OK 73114 • americanfidelity.com
  Sincerely,
  Lorianne *******
  Appeals Counsel
  American Fidelity Assurance Company

• Initial Complaint

  04/13/2024

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  I have had a policy through my work with American Fidelity for 7 years. I cannot afford the coverage. My American Fidelity rep told me I cannot alter the policy. I CANNOT AFFORD IT. Furthermore, I am seeing charges for policies that I didnt agree to.

  

  Business response

  04/18/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on April 13, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that after seven years of being a
  policyholder, she can no longer afford the coverage. However, she has been advised that she
  cannot alter her policy. Additionally, she has noticed charges for policies that she did not agree
  to.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. After receipt of insured’s
  complaint, we found that based on a Benefit Verification/Deduction Confirmation form that our
  insured signed on October 31, 2023 during an enrollment session, for the January 1, 2024 –
  December 31 2024 plan year, she increased her disability policy coverage and maintained
  coverage under her cancer and accident policies. The premiums for the coverages our insured is
  wanting canceled are paid on a pre-tax basis through her employer’s Section 125 Plan. In
  accordance with Internal Revenue Code regulations and her employer’s Section 125 Plan,
  elections for Section 125 Plan benefits are irrevocable for the plan year unless the participant
  experiences a qualifying life event. We have not received any information from her employer
  that the employer approved an election change due to a qualifying life event. Accordingly, there
  is no basis to revoke her election and permit a mid-year cancelation of her policies. Her policies
  remain appropriately active for the plan year of January 1, 2024 through December 31, 2024. If
  our insured does not have a qualifying life event prior to December 31, 2024, upon which to base
  an election change, at the next open enrollment in the Fall of this year, our insured can follow
  the required steps to drop her coverages effective January 1, 2025.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  It is our goal for our insureds to have positive experiences with American Fidelity. We
  invite the insured to contact us if she would like to further discuss the situation.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  04/26/2024

  
  Complaint: ********
  
  I am rejecting this response because: this company uses deceptive business practices. The sales staff is instructed by upper management to use dual screens that are supposedly provided. However, in actuality the sales guy has one screen (facing him.) The issue is when it comes time to sign the small keypad that he slides over the customer has no idea of what is being signed for. The actual screen is not turned to face the customer. In fact if the customer doesnt elect to make changes from the past year the only verbal exchange is ok no changes and theres no visual confirmation of what is being signed for. So there is a perpetual re upping for ANOTHER YEAR. for services that *** never have been wanted. Then when it is discovered by the customer that  are being billed for services that were never agreed to or wanted or utilized the company hides behind the *** 125 tax law and strong arm the cash strapped customer for another calendar year until open enrollment. 
    Even the insurance plan administrators at the school district are seeing charges for elective coverages that they never wanted. This company is a joke.

  
  Sincerely,
  
  *****************************

  

  Business response

  05/01/2024

  Dear Ms. ********:
  This correspondence is in response to the Better business Bureau complaint rejection
  received in our office on April 26, 2024, filed by the above refenced complainant regarding our
  April 18, 2024 response to her initial complaint.
  The complaint rejection submitted by our insured states that American Fidelity uses
  deceptive business practices, perpetual reupping of coverages, and bills for elective coverages
  you never agreed to. Our insured states that American Fidelity hides behind tax law to force
  premium payment until the following year’s open enrollment.
  As previously advised in our initial response dated March 18, 2024, on October 31, 2023
  during an enrollment session, our insured signed a Verification/Deduction Confirmation form for
  the January 1, 2024 – December 31, 2024 plan year. Our insured’s election form shows that she
  increased her disability policy coverage and maintained coverage under her cancer and accident
  policies. The premiums for the coverages our insured is wanting canceled are paid on a pre-tax
  basis through her employer’s Section 125 Plan. In accordance with Internal Revenue Code
  regulations and her employer’s Section 125 Plan, elections for Section 125 Plan benefits are
  irrevocable for the plan year unless the participant experiences a qualifying life event. To help
  ensure Plan compliance, American Fidelity follows this rule and asks the employer to approve
  any mid-year election change. To date, we have not received any information from her employer
  that the employer approved an election change due to a qualifying life event. Accordingly, there
  is no basis to revoke her election and permit a mid-year cancelation of her policies.
  After receipt of the complaint rejection, we contacted the American Fidelity account
  manager with whom our insured worked during the October 2023 enrollment session. Based on
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  our review of her standard enrollment practices, our insured should have experienced a wellinformed enrollment session and was provided a printout of her completed
  Verification/Deduction Confirmation form detailing all elections and payroll deductions. The
  form includes Section 125 Plan rules, including irrevocable changes during a plan year unless a
  qualifying life event occurs. Our insured has met five times in the last seven years and signed an
  election form during each enrollment session.
  As previously advised in our initial response dated March 18, 2024, our insured’s policies
  will remain appropriately active for the plan year of January 1, 2024 through December 31, 2024.
  If our insured does not have a qualifying life event prior to December 31, 2024, upon which to
  base an election change, at the next open enrollment in the Fall of this year, our insured can
  follow the required steps to drop her coverages effective January 1, 2025.
  It is our goal for our insureds to have positive experiences with American Fidelity. We
  invite the insured to contact us if she would like to further discuss the situation.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

• Initial Complaint

  04/09/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I originally signed up for a *********************** Account on October 23rd, 2023. I am a single woman, and I currently have a $500 deductible on my health insurance. When enrolling in the **** I chose to take out $1,000 due to my low deductible, and taking out extra will help cover any copays. Fast forward to February and I submit my first receipt. I see that American Fidelity has my current contribution at over $3,000. I did not sign up for this. I contacted customer support, and they referred me to my school district's contact, he said I must have messed up and been and continued to blow me off and demean me. I looked into this further and found that my Mother, with the same last name, who also works in the same school district, DID take out $3,000 for her FSA account, and while I received no copy of a contract, she received two. No one will admit a mistake, and since I was not given a copy of my contract, they continue to tell me they can do nothing. I am looking for reimbursement or removal for the additional $2,000 they placed on my FSA account that I did not ask for and that I clearly DO NOT NEED.

  

  Business response

  04/19/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office after business hours on April 9, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that she has a Healthcare Flexible
  Spending account (“FSA”) with American Fidelity and she chose to take out $1000. However, in
  February after she submitted her first receipt, she saw that her current contribution was over
  $3000. She states that she did not sign up for this and wants reimbursement or removal of the
  $2000 she did not ask for nor does she need.
  Healthcare Flexible Spending Arrangements are Internal Revenue Code medical
  reimbursement plans that allow participants to deduct wages on a pre-tax basis to pay for eligible
  medical expenses, also on a pre-tax basis. Because of the tax advantages of these plans the
  Internal Revenue Code (IRC) includes detailed requirements for these plans. Accordingly, we
  administer these plans very carefully to help ensure no IRC requirements are violated.
  Healthcare FSA contributions are paid through a Section 125 plan on a pre-tax basis, these
  contributions are subject to Internal Revenue Code Section 125 requirements. For coverage
  elected under a Section 125 plan the election for salary reduction must be made before the
  beginning of the plan year and are irrevocable except for very limited situations that do not apply
  here. If these rules are not followed, the employer could risk the tax treatment for all participant
  contributions. As we record keep the plan in accordance with the IRC requirements and the
  direction from the employer plan sponsor, no change in our insured’s election is possible at this
  time.
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  We assisted with our insured’s employer’s 2024 benefit enrollment at the end of 2023.
  Our records show that our insured completed her enrollment and waived all benefits other than
  a Healthcare FSA for $3,049.92. Email verification of the Benefit Verification is sent systemically
  to the email address in the system. Our insured’s Benefit Verification shows the email address
  we have on file for her and not the one we have for her mother. Additionally, although we do
  not retain the employer’s enrollment forms, the employer is deducting from payroll the amount
  that will result in $3,049.92 for the plan year and forwarding it to us. So, it appears the
  employer’s documentation shows the same election amount. Since there does not appear to be
  an administrative error and no other mid-year change of election event, no election change is
  permitted in accordance with Section 125 regulations. We note that our insured’s employer’s
  Healthcare FSA plan does include a carryover provision. Accordingly, she will be able to carryover
  $640 to the 2025 plan year.
  At American Fidelity, we value our customers and are committed to providing quality
  insurance products and customer care to our valued insureds. If our insured has additional
  questions or other enrollment documentation that indicates an administrative error, she can
  contact our Customer Service Department at 800-662-1113 or the manager whose contact
  information she has.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

  Customer response

  04/23/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  04/09/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I have submitted several claims to American Fidelity and I received a text and email that my claim has been reviewed but when I review my account I do not see any information regarding what decision was made. This is what I had submitted for. 1. I had surgery on Feb 2, 2024 and was out of work for three weeks. All of my sick time was used up prior to my surgery.2. My husband had surgery on Feb 23, 2024 and he was out of work for three weeks. 3. I was my husbands caregiver and I was out of work without pay from Feb *****, 2024. 4. I had 4 visits to the doctors for testing, not consecutive dates.I have not received one ***** from American Fidelity for any of the above listed claims. This has been way longer then expected. This is supposed to be designed to assist with immediate support so that folks do not get behind on their bills. I am now very far behind on my bills. Can you please confirm that I am not paying into a scam so that I can discontinue my participation if this is the case. If this is not a scam, then I am seeking support in receiving an update regarding the status of the claims that I have submitted for, which are listed above. Thank you.I pay American Fidelity $112.32 monthly for this service.

  

  Business response

  04/15/2024

  Dear Ms. ********:
  This correspondence is in response to the Better Business Bureau complaint received in
  our office on April 9, 2024, filed by the above referenced complainant.
  The complaint submitted by our insured states that she submitted several claims to our
  office but when she reviews her account, she does not see information regarding a decision. She
  states that she had surgery on February 2, 2024 and was out of work for three weeks and then
  her husband had surgery on February 23, 2024 and was out of work for three weeks. She states
  that she was his caregiver February 26 - 29, 2024. She states she had four separate visits to the
  doctor for testing. She argues this is taking longer then expected and wants assistance in getting
  an update regarding the status of her claims.
  In order to determine Disability policy benefits, we must receive a complete claim for
  benefits and any necessary records. On February 5, 2024, we received one of the three required
  sections of Ms. ******’s claim form. We mailed her an Explanation of Benefits on February 14,
  2024 requesting she provide the remaining two portions of the claim form. We spoke to her via
  chat on February 14, 2024 providing her an update on her claim status. On February 15, 2024,
  we received the employer portion of the claim form. We spoke to her via chat on February 21,
  2024 providing her an update on her claim status. On February 21, 2024, we received the
  attending physician portion of the claim form. We spoke to her via chat on February 28, 2024
  providing her an update on her claim status. Based on the information provided on her claim
  form and due to the recent September 1, 2023, Effective Date of coverage, we determined a
  review of her medical records would be necessary to rule out Pre-Existing Conditions. On March
  8, 2024, we called Ms. ****** asking for additional information and explained that a Pre-Existing
  Condition review was necessary. We mailed her an Explanation of Benefits on March 12, 2024
  advising that a Pre-Existing Condition review was needed and requested completion of an
  authorization form. Ms. ****** returned the executed authorization, and we are currently in the
  process of requesting and collecting medical records on her behalf. Based on the information
  BBB complaint – BBB ID NO. ********
  Office of Appeals
  P.O. Box 25523 Oklahoma City, OK 73125-0523 • americanfidelity.com
  available to us it appears that the necessary steps are being taken in processing our insured’s
  claim as quickly and efficiently as possible while adhering to applicable policy provisions.
  While there are no applicable benefits under the policy for acting as a caregiver, Ms.
  ******’s coverage does include a Spousal Accident Only Disability Income Rider. We have received
  Mr. ******’s claim form and are currently in the process of reviewing his claim. We called Ms.
  ****** on March 10, 2024 and left a message providing a status for her husband’s claim and
  asking for clarification on information provided on the claim form.
  Ms. ******’s Group Critical Illness Limited Benefit coverage provides a Health Screening
  Benefit once per Calendar Year. We received a Wellness/Health Screening claim form on
  February 5, 2024 requesting benefits for a September 1, 2023 date of service. On February 5,
  2024 we mailed an Explanation of Benefits providing the maximum Health Screening Benefit for
  the 2023 Calendar Year. On March 4, 2024 we received a Wellness/Health Screening claim form
  requesting benefits for December 5, 2023, January 24, 2024, and February 14, 2024 dates of
  service. On March 4, 2024 we mailed an Explanation of Benefits providing the Health Screening
  Benefit for Ms. ******’s January 24, 2024 date of service. Additionally, we advised that the Health
  Screening Benefit was only payable once per Calendar Year and, therefore no additional benefits
  were payable for her other dates of service.
  Our goal is for our insureds to have positive experiences with American Fidelity and we
  invite the insured to contact us if she would like to further discuss the situation.
  Sincerely,
  Lorianne *******
  Office of Appeals
  American Fidelity Assurance Company

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩