ComplaintsforHealthy Paws

• Initial Complaint

  07/02/2024

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  I canceled my policy with Healthy Paws (due to astronomical increase in premiums) effective at the end of my contract. The new contract was set to start on May 23, 2024, so my paid coverage ran through 11:59 PM on May 22. I filed a claim for services on May 22, and was denied based on the claim that my coverage expired at the beginning of the day, not at the end. The new contract would have renewed on 5/23, so if in fact there was an early cancellation, they would have issued a prorated premium reimbursement for that one day. The fact that that didnt happen, proves that my coverage extended through end of day on 5/22. The communications were handled in an unprofessional manner on their end when I continued to reach out via email for an appeal. I emailed back and forth several times with no resolution. The reimbursement for coverage should be $207.09 after taking into account covered services and my 90% reimbursement level. I feel as though I wasn't being treated fairly in this instance because I had canceled my coverage and was no longer a customer they had to try to keep happy. Thank you,

  

  Business response

  07/10/2024

  I am responding to your communication to the Better Business Bureau dated July 2, 2024, regarding your cancellation request and the adjudication of claim number 379421-1-40 for your pet, Pond under your Indemnity Insurance ******* of North America policy. The claim was reprocessed and approved for reimbursement on July 8, 2024.
  
  On May 17, 2024, you submitted a cancellation request with an effective date of May 22, 2024.  On May 20, 2024, an email was sent to you to confirm your cancellation for May 22, 2024, at 12:01 am.  The same day, you cancelled your policy via the link provided to you and a Notice of Cancellation was sent to the email on file. 
  
  On May 22, 2024, Healthy Paws received a claim submission for a same day visit for vomiting and inappetence with a total invoice amount of $289.60. Claim number 379421-1-40 was assigned. On May 23, 2024, the claim was adjudicated and denied as the date of service was outside the policy period. The policy had cancelled effective May 22, 2024, at 12:01 am, as noted on the Notice of Cancellation.  
  

  On May 25, 2024, you reached out to Healthy Paws to request the re-evaluation of the claim. You advised that because your requested date of cancellation was May 22, 2024, coverage should have been afforded for the claim. You were informed that because your cancellation was effective May 22, 2024, at 12:01 am, a same day visit would not be eligible for coverage. A case was opened for the appeals team to further review the claim for coverage. On June 28, 2024, the appeal of claim number 379421-1-40 was denied due to the reasons stated above.
  

  On July 3, 2024, Healthy Paws reviewed this matter pursuant to your July 2, 2024 inquiry. To extend coverage for claim number 379421-1-40, the cancellation effective date was changed to May 23, 2024, at 12:01 am, and coverage was extended for the claim.

  Under appeal, claim number 379421-1-40 was reprocessed under claim number 379421-1-41. The claim was approved for reimbursement in the amount of $207.09, calculated as follows: the total covered amount of $230.10, minus your pets 10% coinsurance of $23.01, for a total reimbursement of $207.09. The Exam for $59.50 was not eligible for coverage pursuant to your policy. Although your policy through Healthy Paws covers the cost of the treatment provided during the veterinary exam, it does not cover the exam itself.
  

  Section II. EXCLUSIONS & LIMITATIONS
  1) GENERAL EXCLUSIONS
  We do not cover:
  a. Veterinary examination fees.
  

  Healthy Paws has handled the processing of your claim in good faith and in accordance with your Pet Health Insurance Policy language and all applicable laws and regulations.
  
  Should you have any questions or concerns, please do not hesitate to contact us. 
  
  Thank you.

  Customer response

  07/10/2024

   
  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.
  
  Sincerely,
  
  *******************************

• Initial Complaint

  06/21/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  This organization jacks up your monthly cost based on how many people have dogs who submit claims in your state, without considering that the total number of people who have dogs in the state is also increasing! Its such a scam; they should be shut down! This sector needs to be highly regulated!There is zero transparency and extremely poor business practices! They continue to increase the cost year over year by more than 50%, yet medical costs have not increased year over year and inflation is basically 3%. Id highly recommend you dont purchase insurance from this provider, as when your pet ages, they basically try to kill your dog by making the cost of insurance unaffordable!

  

  Business response

  06/27/2024

  We are responding to your communication to the Better Business Bureau dated June 21, 2024 regarding a premium increase for ACE American Insurance Company Pet Health Insurance Policy number I09664336.
  

  On June 20, 2024, a Policy Anniversary Communication Notice was emailed to you outlining an upcoming premium adjustment. This notice was provided at least sixty (60) days in advance of the policy anniversary date, in accordance with your Pet Health Insurance Policy terms and conditions. Additionally, a Pet Health Policy Changes Endorsement was provided indicating a new total monthly premium of $451.86, effective August 22, 2024.
  

  In accordance with the terms of the Policy and the associated rating rules, monthly premiums may change for all policyholders. Premiums are determined based on the rates and rating rules filed with and approved by (where required) each states insurance regulator. Premiums reflect the cost of treatment advances in veterinary medicine, characteristics of the individual pet, and other factors, in addition to the overall claims experience for the program within the region where the pet resides. Please note that premiums are not based on a given pets individual claim history; rather, premiums are based on the collective experience of all pets insured.
  

  Please let us know if you have any further questions or concerns. Thank you.

  Customer response

  06/27/2024

   
  Complaint: 21881122
  
  I am rejecting this response because:
  
  Sincerely,
  
  ***********************

  Customer response

  07/08/2024

  They will continue to increase your annual monthly costs by 30-50% year over year (YoY) without providing any transparency on why. The cost of animal medical expenses has not gone up in my area, nor have my dogs medical expenses. Furthermore, the explanation they provide doesnt make sense; its unclear what they are even referring to, and the explanation provided is not consistent with what is shared by their customer service representative. The company is very distrustful and doesnt support helping your pets! Please provide a data-backed, straightforward answer for why youre increasing rates YoY if inflation has not increased, nor have the costs of animal medical care in my area or my dogs medical care costs YoY. Thank you! 

• Initial Complaint

  06/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I recently filed a claim for my cat on 06/04/2024. Due to her abnormal blood test, the vet recommended that she get another test for heart disease. I filed a claim with HealthyPaws as it should be covered under Diagnostics under my policy. I received a rejection a couple days later and called to see how I can appeal the claim. I appealed on 06/05/2024 and received an automated email saying that I would be hearing back in 3 days. I hear NOTHING after 3 business days so I emailed them again and they now told me it usually takes about TWO WEEKS. Its been two weeks now and I still have not heard a thing about my appeal. I have attached all medical records to support my appeal to my initial email. Please find my claims appeal here:I am appealing the denial of Claim 961793-1-11 for my cat Kopi. This was ruled out as a Wellness/Preventative procedure, but it is actually a Diagnostic Test.Initially, my cat Kopi got bloodwork in preparation for her dental cleaning. I know that this is NOT covered and I did NOT file a claim for this. However, it was discovered that Kopis blood test is ABNORMAL, leading the vet to recommend a second blood test to try and diagnose her issues. I filed a claim for the SECOND blood test (which is now for DIAGNOSTIC purposes) and it was approved under Claim 961793-1-10). Upon doing this second blood test, it still came back ABNORMAL. At the doctors recommendation, we did another testing called PROBNP to rule out potential heart conditions that *** be causing elevated **** HCT and HGB levels. I filed a claim for this PROBNP test 961793-1-11 but it was denied. I have attached Kopis medical records along with her ABNORMAL blood tests that indicates that further testing is required to diagnose any illnesses. The sole purpose of this test is DIAGNOSTIC. I am not trying to file a claim for her routine exam, it just happened that during one of her routine exams, we found an underlying abnormality which is now leading to further DIAGNOSTIC testing.

  

  Business response

  06/26/2024

  I am responding to your communication to the Better Business Bureau dated June 19, 2024, regarding the adjudication of claim number 961793-1-11 for your pet, Kopi under your Westchester Fire Insurance Company policy. The claim was appealed and approved for reimbursement on June 21, 2024.
  
  On June 4, 2024, a claim submission was received with an invoice for a same day visit for a proBNP blood test with a total invoice amount of $297.00. Claim number 961793-1-11 was assigned. On June 5, 2024, the claim was adjudicated and denied pursuant to the policys preventive and wellness exclusion.
  II. EXCLUSIONS & LIMITATIONS
  3) PREVENTIVE CARE EXCLUSIONS
  We do not cover:
  b. Preventive healthcare including vaccinations or titer test, flea control, heartworm medication, de-worming, nail trim, and grooming.
  

  On June 5, 2024, you reached out to Healthy Paws to explain that the test was not preventive care, and a case was opened for appeal. The same day, you submitted medical records and lab work to support your appeal. You called on June 11, 2024, and June 18, 2024, and it was explained that your appeal was still in process and that the appeal process can take fifteen (15) to thirty (30) days to complete.
  

  On June 21, 2024, Healthy Paws reviewed this matter pursuant to your June 19, 2024, inquiry. In a review of the medical records received, it was noted that the lab work performed on May 24, 2024 came back with some abnormal values, which lead to the proBNP test.
  

  Under appeal, claim number 961793-1-11 was reprocessed under claim number 961793-1-12. The claim was approved for reimbursement in the amount of $106.40, calculated as follows: the total covered amount of $297.00, minus your pets 20% coinsurance of $59.40, which equals $237.60, applied against your pets remaining annual deductible of $131.20, for a total reimbursement of $106.40.
  
  Healthy Paws has handled the processing of your claim in good faith and in accordance with your Pet Health Insurance Policy language and all applicable laws and regulations.
  
  Should you have any questions or concerns, please do not hesitate to contact us. 
  
  Thank you.
  
  

  
  

  Customer response

  06/26/2024

   
  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

  06/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My pets policy premium was $77.87 on June 20, 2021. Since that time, the policy premium was raised to $165.78, that is an over 200% increase in 3 years time. I made a couple of very small claims within that time period, of which a good portion I still had to pay using the $100 deductible. I'd like an explanation of this unfathomable premium increase during this time period. How is this possible? Of all the insurances one carries, auto, home, health, dental,....none have even come anywhere close to a 200% increase. How can you expect to retain customers, or have your customers give positive referrals to your service while you operate in this scam like manner. Please explain without giving bullsh*t excuse that the underwriters are the ones to blame.

  

  Business response

  06/27/2024

  We are responding to your communication to the Better Business Bureau dated June 19, 2024, regarding a premium increase for ACE American Insurance Company Pet Health Insurance Policy number I09211512.
  

  On April 18, 2024, a Policy Anniversary Communication Notice was emailed to you outlining an upcoming premium adjustment. This notice was provided at least sixty (60) days in advance of the policy anniversary date, in accordance with your Pet Health Insurance Policy terms and conditions. Additionally, a Pet Health Policy Changes Endorsement was provided indicating a new total monthly premium of $165.78 effective June 20, 2024.
  

  In accordance with the terms of the Policy and the associated rating rules, monthly premiums may change for all policyholders. Premiums are determined based on the rates and rating rules filed with and approved by (where required) each states insurance regulator. Premiums reflect the cost of treatment advances in veterinary medicine, characteristics of the individual pet, and other factors, in addition to the overall claims experience for the program within the region where the pet resides.Please note that premiums are not based on a given pets individual claim history;rather, premiums are based on the collective experience of all pets insured.
  

  Please let us know if you have any further questions or concerns. Thank you. 

• Initial Complaint

  05/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Healthy Paws is trying to not reimburse on claim #******-1-60 from 11/14/23 and they keep claiming documents have not been received or come up with another way to not reimburse for a simple annual exam for my pet. I've sent the files now 12 times with 37 emails of correspondence with confirmation of receipt from their system and people. They keep closing the claim without my knowledge and then will say they do not have a particular file, which is actually showing in their portal. At this point, they are not reimbursing me for things that are covered by my pet insurance plan. I've been proactively trying to get this resolved for the last 6 months with no help. At this point, I'm concerned that they are evading reimbursement of items that I pay monthly for them to insure.

  

  Business response

  06/03/2024

  
  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company (***********), is responding to your communication to the Better Business Bureau dated May 24, 2024, regarding the adjudication of claim number 342098-1-60.  The claim was missing documentation to be adjudicated.
  

  On November 14, 2023, Healthy Paws received a claim submission for a same day visit for bloodwork and prescription medications in the amount of $381.85. Claim number 342098-1-60 was assigned. The invoice included a charge for Discount (OPEN BOTTLE -40) for $6.00.  Healthy Paws was unable to determine coverage for this item. Requests for claim visit medical records were sent to you and your clinic between November 17, 2023 and February 12, 2024. These requests were to verify this charge and eligibility for coverage. On December 21, 2023, medical records were received from *********************************** spanning November 9, 2023 to December 19, 2023. However, these records did not clarify the invoice charge details. On February 15, 2024, the claim was closed due to missing documentation and the length of time it had been opened. Healthy Paws was unable to determine coverage for the claim submission with the documentation provided.
  

  On May 28, 2024, Healthy Paws reviewed this matter pursuant to your May 24, 2024 inquiry. *********************************** was contacted to obtain clarification on the item of Discount (OPEN BOTTLE -40) for $6.00. After a thorough review of your account, it was determined that this was supposed to be a -$6.00 discount applied to the Active Again prescription on the invoice, and the invoice total was supposed to be $369.85, and not $381.85. It was also confirmed that you had been credited for this error with your veterinary hospital.
  

  On May 28, 2024, claim number 342098-1-60 was reopened and processed with an invoice total of $369.85. It was approved for reimbursement in the amount of $204.00, calculated as follows: the total covered amount of $255.00, minus the policys 20% coinsurance of $51.00, for a total reimbursement of $204.00. The Examination and ******* approved medications were not eligible for coverage pursuant to your policys exclusions.

  Section II. EXCLUSIONS & LIMITATIONS
  1) GENERAL EXCLUSIONS
  We do not cover:
  a. Veterinary examination fees.
  Section V. DEFINITIONS
  16) Medication. Any veterinary recommended medications prescribed by your veterinarian and approved by the Food and ******************* ***** for        veterinary use.
  30) Veterinary Examinations Fees. **** charged for the professional opinion of a veterinarian. Also referred to as consultation, examination, referral, and recheck fees.

  Healthy Paws has handled the processing of your claim in good faith and in   accordance   with   your   Pet   Health   Insurance   Policy   language and all applicable laws and regulations.
  
  Should you have any questions or concerns, please do not hesitate to contact us. 
  
  Thank you.
  

  
  

  Customer response

  06/03/2024

   
  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. I do want to note that what they mentioned in their response is not what happened and that I've tried to resolve this with them after contacting them over 37 times and it wasn't until filing this BBB compliant that they resolved the matter. 
  
  Sincerely,
  
  ***************************

• Initial Complaint

  05/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I enrolled with healthy paws in 2021. In an email dated 12/3/21 it says if your pet is 6 years old or younger and been seen by a vet in the last 12 months then there is nothing else needed. I submitted medical records showing those vet visits. I was never informed by the company from 2021-2024 that I needed an exam. They accepted my premium every month as if I was covered. I submitted a claim this ************* saying an initial exam was required. They stated because I dont have one on file this vet visit would be considered the initial exam & any issues would be considered pre-existing. 1. I was informed in writing I did not need an exam. 2. I was never notified I needed an exam. 3. You continued to collect my monthly payment as if there was coverage.

  

  Business response

  05/30/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company (***********), is responding to your communication to the Better Business Bureau dated May 23, 2024, regarding the adjudication of claim number 1109752-1-1.  The claim was adjudicated and approved for reimbursement on May 24, 2024.
  

  On May 22, 2024, Healthy Paws received a claim submission for a same day visit for vaccinations as well as diagnostics and treatments for pain with a total invoice amount of $639.17. Claim number 1109752-1-1 was assigned. Prior to the receipt of the claim, medical records were received for **** on December 17, 2021 from *********************************************************************** spanning April 8, 2020 to June 9, 2021. A request for updated medical records with doctor notes was sent to you on May 23, 2024, as the history received was incomplete. Additionally, a fax request was sent to your veterinary clinic for complete medical records. The same day, medical records were received spanning April 8, 2020 through May 23, 2024, including ***** claim visit on May 22, 2024. The records were attached to the claim on May 24, 2024 and the claim was waiting for the next available claims adjuster to review and process it.  
  

  In general, a request for complete medical records upon the first claim is necessary to provide a history of the pets past medical conditions, illnesses, and/or veterinarian services.  This allows any pre-existing condition(s) that would be excluded from coverage under your policy to be identified and to determine coverage for any new condition. 
  

  On May 24, 2024, Healthy Paws reviewed this matter pursuant to your May 23, 2024 inquiry. On May 23, 2024, you called to inquire about the status of your claim. Unfortunately, you were misinformed that the required enrollment examination was still needed to determine coverage for the claim. In review of the claim, it appears that the claims processor indicated that an enrollment examination was still needed, rather than claim visit medical records. We apologize for any confusion this may have caused. Please rest assured that this did not cause any delay in the adjudication of your claim. 
  

  On May 24, 2024, claim number 1109752-1-1 was adjudicated and approved for reimbursement in the amount of $156.58, calculated as follows: the total covered amount of $508.23, minus your 20% coinsurance of $101.65, which equals $406.58, and applied towards your $250.00 annual deductible, for a total reimbursement of $156.58. The vaccinations and examination were not eligible for coverage pursuant to your policy.
  

  Section II. EXCLUSIONS & LIMITATIONS
  1) GENERAL EXCLUSIONS
  We do not cover:
  a. Veterinary examination fees.
  3) PREVENTIVE CARE EXCLUSIONS
  We do not cover:
  b. Preventative healthcare including vaccinations or titer test, flea control, heartworm medication, de-worming, nail trim, and grooming.
  

  Healthy Paws has handled the processing of your claim in good faith and in   accordance with your   Pet   Health   Insurance   Policy language and all applicable laws and regulations.
  
  Should you have any questions or concerns, please do not hesitate to contact us. 
  
  Thank you.

  
  

  Customer response

  05/30/2024

   
  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

  05/21/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  My dog had severe hives that were not treatable with the allergy medication he was on. The vet recommended an allergy test. I called healthy pad to see if the test was covered, and was told they could not tell me unless I filed a claim. I told them I needed to know prior to scheduling the service, as it is not customary for insurance to decide after a procedure whether or not it is covered. I was then informed I could file for a direct payment claim: the service would go through a pre-approval process, and healthy paws would pay the vet directly for their portion of the claim. We went through this process, the claim was approved, we got the allergy tests, the vet spoke to healthy paws after the procedure and they confirmed everything was good to go on their end. I received emails stating that the claim was processing, then that is was closed. About a week ago I received an email that a duplicate claim had been filed (it had not). Yesterday healthy Les emailed me and my vet to let me know that a payment had been sent to me by accident instead of the veterinary office, and it was now up to us to resolve the payment ourselves. Neither I nor the vet has received any payment from healthy paws, nor any receipt or proof of payment. I called customer service yesterday and was told the direct pay department is completely separate from customer service, and cannot be reached by phone. I have emailed back and as of yet received no response. I spoke to the vet today and confirmed they have still not received the payment that healthy paws agreed to issue.

  

  Business response

  05/30/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company (***********), is responding to your communication to the Better Business Bureau dated May 21, 2024, regarding the adjudication of claim number 1046335-2-22.  The claim was approved for reimbursement on April 30, 2024, with reimbursement provided via direct deposit.
  

  On April 16, 2024, a direct payment was set up and approved by our direct payment team for Ygors upcoming allergy testing with *************************. On April 26, 2024, Healthy Paws received the finalized invoice for Ygors allergy testing that was performed that day with a total invoice amount of $552.26. Claim number 1046335-2-22 was assigned. Unfortunately, the claim did not go through the direct payment team to be processed.  Instead, the claim was processed as a regular claim submission in error with direct deposit to your account.  ******************** Paws has provided additional training to the claims processor that adjudicated your claim.
  

  Claim number 1046335-2-22 was approved for reimbursement in the amount of $366.61, calculated as follows: the total covered amount of $458.26, minus your 20% coinsurance of $91.65, for a total reimbursement of $366.61. The Examination for $94.00 was excluded from coverage pursuant to your policy.Please note that although the policy covers the cost of the treatment provided during the veterinary exam, it does not cover the exam itself.

  Section II. EXCLUSIONS & LIMITATIONS
  1) GENERAL EXCLUSIONS
  We do not cover:
  a. Veterinary examination fees.
  Section V. Definitions
  30)  Veterinary Examinations Fees. **** charged for the professional opinion of a veterinarian. Also referred to as consultation, examination, referral, and recheck fees.
  

  Reimbursement via direct deposit was approved on April 30, 2024, and a claims completed email was sent to you the same day confirming reimbursement was being sent shortly.
  

  On May 20, 2024, the direct pay team sent you and ************************* an email to let you both know that reimbursement had been sent to you by mistake, rather than a direct payment being sent to ************************* as planned. Additionally, a Customer Liaison Manager attempted to reach out to you by phone and email on May 21, 2024, and again on May 23, 2024, to try and resolve the issue.  On May 23, 2024, you informed Healthy Paws that thepayment had been received.   

  Healthy Paws has handled the processing of your claim in good faith and in   accordance   with   your   Pet   Health   Insurance   Policy   language and all applicable laws and regulations.
  

  Should you have any questions or concerns, please do not hesitate to contact us. 
  
  Thank you.
  

  
  

• Initial Complaint

  05/17/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have used Healthy Paws for my Boxers entire life and the last year has been atrocious - I have had numerous claims denied without anyone reviewing medical records and then have to fight with multiple people to get it reopened. He has kidney disease that is unable to be treated so every time we see a specialist or even our general vet we have issues and we cant even switch providers. We are stuck with a company that clearly doesnt care about its clients or their pets anymore. I have requested to file a formal complaint with them directly as well to hopefully deter other people from dealing with what I have been dealing with. I worked in vet med for 10 years and used to recommend them, but now theyre just like every other horrible insurance carrier. Do not waste your time and money!

  

  Business response

  05/24/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company (***********), is responding to your communication to the Better Business Bureau dated May 17, 2024, regarding the adjudication of claim number 463899-4-45.  The claim was denied due to the policys examination and preventive care exclusion. The claim was appealed and reprocessed under claim number 463899-4-46 on May 20, 2024, after the receipt of the requested documentation needed to verify coverage.
  

  On April 7, 2024, Healthy Paws received a claim submission for a visit on April 2, 2024, for a wellness exam with vaccines, heartworm test, and senior bloodwork in the amount of $351.95. Claim number 463899-4-45 was assigned. On April 17, 2024, the claim was adjudicated and denied pursuant to the policys examination and preventive care exclusion.
  

  II. EXCLUSIONS & LIMITATIONS
  1) GENERAL EXCLUSIONS
  We do not cover:
  a. Veterinary examination fees.
  3) PREVENTIVE CARE EXCLUSIONS
  We do not cover:
  b. Preventive healthcare including vaccinations or titer test, flea control, heartworm medication, de-worming, nail trim, and grooming.
  

  On April 17, 2024, you called to inquire about the claims denial and an appeal case was opened for review. On May 4, 2024, an email was sent to you from the appeals team informing you that medical records for the claim visit on April 2, 2024 were needed to determine coverage for the appeal of claim number 463899-4-45. On May 16, 2024, a follow-up email was sent notifying you that the medical records were still needed. The same day, you replied saying that you had received medical records from your clinic and included it in your response. You also inquired about why the claim was denied without medical records in the first place. The appeals team replied to your email on May 17, 2024 and let you know that there was no documentation or medical records attached to your email. As you had not included medical records with the claim submission, and the invoice line items indicated the visit was preventive care, it was denied under your policys exclusions. You were advised that an appeal of the claim could be granted upon receipt of the necessary medical records. The same day, you replied with a copy of the medical records. These were waiting to be reviewed by the appeals team upon receipt of your inquiry.
  

  On May 20, 2024, Healthy Paws reviewed this matter pursuant to your May 17, 2024, inquiry. Medical records for the claim visit on April 2, 2024 were reviewed clarifying the need for a Senior Profile bloodwork as a recheck for an abnormal blood profile previously performed for kidney issues.  Without these additional notes that were received, the Wellness Exam, along with the other preventative treatments on the invoice, indicated that the bloodwork was being performed for preventative and/or wellness care reasons. 
  

  Claim number 463899-4-45 was appealed and reprocessed under claim number 463899-4-46. The claim was approved for reimbursement in the amount of $86.08, calculated as follows: the total covered amount of $206.75, minus your 10% coinsurance of $20.67, which equals $186.08, and applied towards your $100.00 annual deductible, for a total reimbursement of $86.08. The Wellness Exam with Vaccines and Heartworm were not eligible for coverage pursuant to your policy, as noted above.
  

  In review of your account, there were two (2) other instances where an appeal request was made. This includes claim number 463899-4-3, which was appealed under claim number 463899-4-4 and approved for reimbursement in the amount of $81.91. As well as claim number 463899-4-41, which was appealed under claim number 463899-4-43 and approved for reimbursement in the amount of $239.02. Both requests were reviewed, and the claims were appealed within days of receipt of the necessary documentation. Please note that senior bloodwork is a standard part of a routine well check.  Without documentation and/or notes from the provider, the claim adjudication can be delayed and even denied. 
  

  Healthy Paws has handled the processing of your claim in good faith and in accordance with your Pet Health Insurance Policy language and all applicable laws and regulations.
  
  Should you have any questions or concerns, please do not hesitate to contact us. 
  
  Thank you.

• Initial Complaint

  05/17/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have received a Warning Message from Apple Security that My Historical Private information from Healthy Paws Insurance was compromise finding my information on the Dark Web. Where this might result exposure of Personal and Private information such; Password, Email user, Address, Credit Card Information etc. Considering that the US reinforces Laws and Regulations that protects me and others of such breach I am requesting a HelathyPaws Insurance Company to explain why my information was Not email was sent to me informing of such Breach in which I am also entitled HelathyPaws to provide monitoring of my information. Also there is PCI -DSS that have implications on my Credit Card information protection.

  

  Business response

  06/03/2024

  Healthy Paws Pet Insurance, LLC is responding to your communication to the *************************** dated May 17, 2024, regarding a purported warning message.
  

  Healthy Paws takes the protection of our customers personal information seriously.  To the best of our knowledge, Healthy Paws has not experienced a data security incident that would have impacted your information. If for any reason your concern is not resolved, please contact Healthy Paws directly at ************** with any supporting documentation or information concerning this matter, so that we can try to assist you further. 

  Customer response

  06/03/2024

  My security report that my Personal information (User, Name, email and Pwd) was found in the Dark Web. This is a sign that my information was exposed in your end The fact that I am CISSP and take extreme care about my personal information even though I am not your customer for more than 5 years or so. It shows that this needs a formal answer from your company to explain how and why my information was found in the Dark Web perhaps other customer are also expose and considering that they are not properly informed. Please provide a formal answer. I am giving you an opportunity to double check your response. 
  

• Initial Complaint

  05/07/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My policy for my dog carries a $500 deductible and a 70% reimbursement rate. They are applying the reimbursement rate to calculate my deductible therefore making the amount I need to pay toward a $500 deductible increase to $714 before they will start reimbursement. Why does my reimbursement rate impact the deductible? Research I have done corroborates my belief that once I submit $500 in bills, I should begin getting reimbursed. Are they allowed to use this calculation to increase what I have to pay to over $200 more?? Is it even legal? I will attach article from *************** which illustrates my understanding of the fact that $500 deductible should be $500!

  

  Business response

  05/15/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of ACE American Insurance Company (ACE), is responding to your communication to the Better Business Bureau dated May 7, 2024, seeking additional clarification to the application of the policys reimbursement.
  With regards to how reimbursements are calculated, please refer to page 1, Section I.under INSURING AGREEMENT, and subsection 3) and 4), which reads as follows:

  I. INSURING AGREEMENT
  We rely on the statements you made in the application. Upon your payment of the premiums when due, we will provide coverage as specifically described in this policy for your pet as shown on the declarations page.
  

  Benefits are subject to terms, conditions, limitations and exclusions of this policy and to your responsibility for the coinsurance and deductible.
  3) COINSURANCE: The portion you are required to pay for your pets veterinary treatment. Your pets coinsurance amount is shown on the pet schedule of the declarations page.
  4) DEDUCTIBLE: Your pets deductible is shown on the pet schedule of the declarations page. Your pets deductible shall apply once per coverage term
  

  Additional information about Healthy Paws claim reimbursement calculation can be found in the Frequently Asked Questions section of the Healthy Paws website. Please see subsection Filing Claims, Question 5, How is reimbursement calculated. It is here that a sample calculation is also provided. This information is available to all customers prior to enrollment.
  

  Bacis Reimbursement level is 70% (which gives a Coinsurance level of 30%). Claim reimbursements are based on the total covered treatment amounts, multiplied by the pets reimbursement level, and then applied against the pets remaining annual deductible. Reimbursements are paid out for the covered charges only after the annual deductible is satisfied. Below is a sample calculation. 

  On May 3, 2024, Healthy Paws received a claim submission for a same-day visit for Bacis heart medication with a total invoice amount of $167.27. Claim number 372320-1-46 was assigned. The same day, the claim was adjudicated and approved for reimbursement in the amount of $117.09, which was applied towards your pets annual deductible, calculated as follows: the total covered amount of $167.27, minus the policys 30% coinsurance of $50.18, which equals $117.09, applied against the pets annual deductible of $500.00, which leaves a remaining annual deductible of $382.91.
  

  Healthy Paws has handled the processing of your claim in good faith and in accordance with your Pet Health Insurance Policy language and all applicable laws and regulations.
  

  Should you have any questions or concerns, please do not hesitate to contact us.Thank you. 

   

  Customer response

  05/15/2024

   
  Complaint: 21678034
  
  I am rejecting this response because:
  I signed an agreement for $500 deductible and 70% reimbursement.  I did not agree or sign your frequently asked questions page where you demonstrate applying my reimbursement calculation to the deductible and thereby increase my deductible to over $200 more.  I would question if this is legal.
  Sincerely,
  
  ***************************

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