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  • Aflac Physician Visit Claim Form

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Your physician should complete and sign Section C: Physician's Statement. ... This claim form should be completed on or after the initial date of your disability, hospitalization, and/or surgery.

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The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

1If all documentation is not available upon initial claim filing, you may upload the documents later by clicking “Upload Documents” on the mobile app or “MyClaims” on desktop. Register or Log in: Go to aflac.com/myaflac or download the Aflac SmartClaim Mobile app from the App Store or Google Play Store. One Day Pay*.

Do I get my money back if I cancel Aflac? Your coverage will last until the end of the month before it gets canceled. If you cancel Aflac life insurance and it has a cash value, you will receive that amount back when your policy ends.

Post Office Box 84075 * Columbus, GA. ... WELLNESS AND HEALTH SCREENING CLAIM FORM. ... AUTHORIZATION. Any person w ho knowingly and w ith intent to defraud any insurance company, files a statement of claim containing any materially false, incomplete or misleading information, is guilty of a crime.

Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form).

You can mail your claim form to Post Office Box 84075, Columbus, Georgia 31993. You may also fax your claim form to our claims department at 866.849. 2970 or scan and email your claim form to groupclaimfiling@aflac.com.

Log in to your account to check the status of your claim. From there, you'll be able to check claim status, upload additional supporting documents if needed, and view your explanation of benefits. You may also check claim status by chat or phone by calling us at 800.992.3522.

Aflac wellness claims pay you money for staying on top of your health by getting yearly checkups and medical screenings such as physicals, dental exams and eye exams. Most Aflac Accident, Hospital Indemnity and Cancer Insurance policies have wellness benefits.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232