ComplaintsforHealthy Paws

• Initial Complaint

  07/01/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  My annual pet insurance is going up almost 50% in August, 2022. It already increased almost 50% last year. When I try to reduce the premium by decreasing the coverage from 90% to 70%, the price increases when it should decrease. I called and spoke to a representative and a manager, and they just keep saying its because of the state I live in. I believe there must be some mistake, because the insurance for two cats and three dogs is completely unaffordable at this point. I would like the company to look more closely into the price of my pet insurance.

  

  Business response

  07/11/2022

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of ACE ******** Insurance Company, is responding to your communication to the Better Business Bureau, dated July 1, 2022 regarding a premium increase and quote discrepancy for *** Health Insurance Policy number I09654598.

  On June 10, 2022, a Policy Anniversary Notice Communication was provided to you outlining an upcoming premium adjustment. This notice was provided at least 60 days in advance of the policy anniversary date, in accordance with your *** Health Insurance Policy terms and conditions. Additionally, a *** Health Policy Changes Endorsement was provided indicating a new total monthly premium of $587.00, which will take effect on August 12, 2022. Attached hereto, please find Exhibit A, Policy Anniversary Notice, and Exhibit ** *** Health Policy Changes.

  In accordance with the terms of the *** Health Insurance Policy and the associated rating rules, monthly premiums *** change for all policyholders. Premiums are determined based on the rates and rating rules filed with, and approved by, each states insurance regulator, which reflect the cost of treatment advances in veterinary medicine, and characteristics of the individual pet, in addition to the overall claims experience for the program within the region where the pet resides.

  As a result of a new filing with the state, some ****** policyholders were scheduled to receive significant annual premium increases. To reduce the impact of these increases, the ****** Division of Insurance approved ACE ******** Insurance Company to cap the annual premium increases at 50%. Adjusting any policy options drops the cap and your premium would be charged at the full amount, without the cap. Specifically, you would lose your cap for ***** ****** and Nutmeg, as they are all currently capped at a 50% increase. Without the cap, Emmys premium would increase from $179.02 to $213.65, and Hardy and Nutmegs premiums would both increase from $140.55 to $206.33 with the current coverage options. This means that you would need to select a significantly lower coverage combination to see a lower monthly premium for these pets.

  We are unable to make any changes to the premium rating that would deviate from those filed with, and approved by, the state. However, we encourage you to call our *********************** at ************ to learn more about other coinsurance and deductible options that *** better meet your needs.

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

  Thank you.

   

   

   

   

   

• Initial Complaint

  06/22/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I have reached out to this organization since April trying to get a response. I submitted my vet **** to healthy paws and they declined it. I was seeking information on why the claim was declined as it appeared within the bounds of my subscription. I have never received a response to my multiple outreaches over the last 2 months.

  

  Business response

  06/30/2022

  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 June 23, 2022, regarding the adjudication of claim number 1110693-1-1 and a customer service issue.  
  
  On March 26, 2022, Healthy Paws received a claim submission for a visit on March 24, 2022, for an Emergency Visit, antibiotics, and cough tablets in the amount of $142.00. Claim number 1110693-1-1 was assigned. On April 11, 2022, the claim was adjudicated and approved for reimbursement in the amount of $29.60, which was applied towards your annual deductible, calculated as follows: the total covered amount of $37.00, minus your 20% coinsurance of $7.40, which equals $29.60 and applied towards your $250.00 annual deductible. The Emergency Visit fee for $105.00 was not eligible for coverage pursuant to your policy. Although your policy through Healthy Paws Pet Insurance covers the cost of the treatment provided during the veterinary exam, it does not cover the exam fee itself. A claim completed email, which included the following policy exclusion, was sent to you on April 11, 2022.  
  
  Section II. EXCLUSIONS & LIMITATIONS
  
  1) GENERAL EXCLUSIONS
  We do not cover: 
  a. Veterinary examination fees.
  
  Section V.Definitions
  
  30)Veterinary Examinations Fees.   Fees charged for the professional opinion of a veterinarian. Also referred to as consultation, examination, referral, and recheck fees. 
  31)Veterinary Treatment means:
  a.X-rays; 
  b.Laboratory and diagnostic tests; 
  c.Medication; 
  d.Surgeries; 
  e.Supplies; 
  f.Hospitalization; 
  g.Euthanasia; and 
  h.Nursing care; 
  provided by a licensed veterinarian and their staff under direct supervision. 
  
  On April 11, 2022, you responded to the claims completed email sent to you and asked for further clarification.  As you didnt receive a response, you made another request on May 19, 2022. 
  

  Regarding the emails that you sent in reply to your claims completed email, we sincerely apologize for not responding. The emails went to our general mailbox and are typically responded to within several business days.  Healthy Paws is putting steps into place to prevent this from happening in the future.
  
  On June 23, 2022, a Senior Claims Adjuster reviewed your account. As noted above, the claim was covered and applied towards your pets annual deductible. However, the Emergency Visit was excluded from coverage pursuant to your policy.  ********** visit is not covered regardless of if the exam is from a general practice veterinarian, specialist, or emergency hospital.  Your policy defines Veterinary Examinations Fees as "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. 
  
  In future events where you would need our assistance, feel free to reach out to our customer care service representatives directly by emailing us at ************************************ emailing us from our website at www.healthypawspetinsurance.com, or calling us during normal business hours Monday - Friday from 7:00 AM to 5:00 PM PST and Saturday from 8:00 AM to 5:00 PM PST at **************.
  
  Thank you.

  
  

• Initial Complaint

  06/21/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I adopted a dog in the summer of 2018 and immediately acquired health insurance at the rate of $65 per month. Despite the fact that I paid on time (set up automatic payments) and only had one significant claim, Heathy Paws began a steady increase in my premiums and by February 2022, 3 1/2 years later, had increased my premium to 150% of the original premium. When my wallet was stolen in April 2022, I failed to update my credit card information for automatic payments and therefore missed my May payment. Healthy Paws mailed me a notice that they would cancel my dog's insurance if not paid by last, week, which I would have gladly done but I was on vacation and didn't get the notice until it was too late. When I called to rectify the situation, a Heathy Paws representative told me that they would not reinstate the insurance, I would have to reapply. He confirmed that all of the ailments my dog had between the time I initially bought insurance, to date, would count against my dog as preexisting conditions. My dog has been very healthy, so this will have little practical consequence in my case, but it seems apparent to me that Healthy Paws is using underhanded business practices to increase premiums and reject medical claims. I am currently looking for a new insurance, but would like Healthy Paws to partially reimburse me for the extraordinary increase in premiums, when they never sent me written notice in the mail about these premium increases. I will be contacting the company directly requesting partial reimbursement. When I did some research today I noted several class actions lawsuits against Healthy Paws for similar, purportedly unjustified premium hikes. BUYER BEWARE.

  

  Business response

  06/30/2022

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter of Westchester Fire Insurance Company, is in receipt of your correspondence dated June 21, 2022 regarding your request for a partial refund and possible reinstatement of your cancelled policy number I18494474.

  As stated in Section IIII. GENERAL CONDITIONS, Subsection 1:
  

  Premium is payable monthly by Direct Debit or by charge to your credit card, according to the option selected by you on the application. This policy is continued until cancelled and will automatically renew each month as long as premium payments are current. When you have not paid the premium, we may cancel this policy. We will let you know at least twenty (20) days before the date cancellation takes effect.

  Your billing date is the 16th of each month. On May 16, 2022, Healthy Paws was unable to collect your monthly premium using the payment method on file. An email notice was sent the same day to advise you of the account suspension, and to provide advance notice that the policy was in danger of cancellation unless the premium due was received. A second notice was provided on May 19, 2022, further giving you advance warning of the cancellation of the policy due to non-payment. On May 23, 2022, a final email correspondence was sent notifying you of the cancellation, effective June 13, 2022. In addition, a Notice of Cancellation was provided to you via United ********************** mailed on May 19, 2022. Please find attached Exhibit A, Suspense emails and Exhibit B, your Notice of Cancellation.
  

  Subsequent to the notification being sent, you did not update the billing information on the online **************** nor did you contact us in regard to the cancellation notice until June 21, 2022. Your policy was canceled for nonpayment of premium in accordance with the terms and conditions of the policy and applicable laws and regulations.
  

  We appreciate your clarification regarding the theft of your wallet and details behind the card rejection. We will be happy to consider reinstatement of your account if you wish to continue your coverage. Please provide a police report or other official documentation as proof that your credit card (wallet) was lost and/or stolen. Once we receive proof of loss, then we can proceed with the necessary steps for reinstatement of your account which will also require past premiums to be paid, bringing the account current. If you wish to proceed, please contact us within 15 days of the date of this response to the Payments Team at *************************************.

  In regard to your policy premium, annual reprice notices were provided to you via email correspondence on December 19, 2019, December 19, 2020, and December 16, 2021. We are unable to make any changes to the premium rating that would deviate from those filed with, and approved by, the state, this includes billing adjustments and refunds. Please find Exhibit C, copies of the Anniversary Renewal Notices that were send to the email on file.
  

  Please do not hesitate to contact me if you have any questions or need any additional information.
  

  Thank you.

   

  Customer response

  07/01/2022

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is accurate, but still unsatisfactory.  The business did not leave contact information to proceed as suggested. I will need to search for a way to send them proof that m y wallet was stolen. 
  
  Sincerely,
  
  *****************************

• Initial Complaint

  06/14/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This is now be my FIFTH writing regarding the licensee. The licensee pattern and practice of insurance bad faith involving the licensee failing to communicate in a timely manner.On June 1st 2022 I had emailed the following:Pet Parent(s)************************* *********************************************************** ROONEY was the shelter name for now APOLLO adopted 05/31/2022. I was instructed by https://myaccount.healthypawspetinsurance.com/addpet Sorry We are unable to enroll new policies on your current account. To enroll a new pet, you can do so by creating a new account. Your new account will need to be created using a different email address and it will have a separate billing date. We apologize for the inconvenience. Please click here to start a new quote.Therefore APOLLO Policy Number: ********* APOLLO different email address is patient-octant-************* Would you be able to now add APOLLO to the existing Policy Number: 673900?Is this separate account now added to the existing account?On June 6th 2022 1:02 P.M. CENTRAL TIME, during an eleven minute phone call I had made a second request checking the status of adding a petIs this separate account now added to the existing account?TODAY 06/14/22 is the third request.After sending communication to ******* **** CHC, CHPC, CCEP compliance professional Healthy Paws Pet Insurance and foundation and others I discovered that now the existing policy is canceled and the second pet was not transferred. It is my experience writings are ignored until communication includes ********* Office of the Commissioner of Insurance. In the future I should be effortless to add a pet to a policy as it was in 2019. Healthy Paws should be able to hire an accomplished web developer to get this done.In the future writings from customers should not be ignored In the future follow up phone calls to the already over burden call center should not be necessary.

  

  Business response

  06/21/2022

  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 June 14, 2022 regarding a service issue for Pet Health Insurance Policy number I24865198.
  
  Due to a new filing in your state since the inception of your previous account for ******* and **** Healthy Paws is unable to add additional pet policies to that account. In order to enroll new pets, a separate account must be created, which you have already completed for Apollo. Your new account for Apollo, which became effective June 1, 2022, was correctly written in the newest filed and approved pet insurance plan for your state with Westchester Fire Insurance Company.
  
  As you are aware, with the recent passing of *******, your previous account was cancelled effective May 30, 2022. You were notified of this in the confirmation email for claim number 673900-2-66, sent to you on June 8, 2022. A prorated premium refund was issued on June 14, 2022, for your recently cancelled policy, using the payment method on file.
  
  If you would like to continue to use the same email address you used on your previous account, *********************** for your new account for Apollo we can update this information for you if this would be helpful. 
  
  We have provided a direct contact for you, sent in a separate response to your emailed inquiry received June 14, 2022.  Please let us know if you would like to update your email on your new account for Apollo. 
  
  Please let us know if you have any further questions or concerns. 
  
  Thank you.

  Customer response

  06/21/2022

   
  Complaint: 17425612
  
  The author did speak to the issue as to who is the general underwriter. 
  
  
  The Licensee produced policies underwritten exclusively by Ace from January 17, 2013 until June 17, 2016. 
  
  
  The managing general underwriter, PER the author, is now Westchester Fire Insurance Company and HEALTHY PAWS PET INSURANCE , LLC (the licensee) is the insurance company license to do business in the state of *********. 
  
  
  Past complaints did compel the Licensee to correct a ********* addendum with correct contact information sufficient to resolve complaints.   Past communication, advertisement of, by, or on behalf of this insurer did not set forth the name in full of the insurer and the location of its home office or principal office, if any, in ***************** (if an alien insurer).
  
  
  The author did not speak to how it would improve its electronic-based underwriting and communication to ********* residents and myself.  A email messages on June 1 2022 and a phone call which misrepresented the possibility of adding a pet to an existing account on June 6, 2022 1:02 p.m. (11 minute) did not accomplish this task.  The author failed to address why communication was only answered 15 days later after a third attempt, a June 14 2022 email to the following:
  
  
  CHC/CHPC/CCEP compliance professional Healthy Paws Pet Insurance and foundation, healthy Paws Pet Insurance info, CHUBB ** customer service, Director of corporate compliance Healthy Paws Pet Insurance, AON a consulting professional services firm, past underwriter of ACE now Westchester, corporate compliance officer, and a senior claims adjuster. 
  
  
  The licensee shall cease bad faith practices and improve its communication with myself and other residents of the state of ********* who conduct business with the licensee according to the licensee pet health insurance policy. 
  
  
  I asked the author to answer the following:
  
  
  Why did it take three attempts including a email to all involved parties regarding ********* ****** of ************ of Insurance file number ****** to get a response?  
  
  
  How will the licensee improve its communication in the future when its underwriting is based on internet communication?
  
  
  *************************
  
  Sincerely,
  
  *************************

• Initial Complaint

  06/02/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I've had healthy paws as my pet insurance for 8 years and pay this company on average about $2000.00 in premiums per year. This company has an awful claims process and the at home agents they employ are allowed to treat customers anyway they choose and one of the biggest problems with the awful service this company provides. This company was supposed to direct pay a claim yesterday and they knew i was sitting in a the parking lot waiting on this payment and one of the "tier 2" support agents hung up after she wasn't able to get any assistance from her management via chat. The claim never got paid and they left me like this!! I have paid this company thousands in premiums and this is how they handle claims!!

  

  Business response

  06/10/2022

  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 June 2, 2022, regarding your customer service experience and direct payment request.
  

  In your complaint you mentioned your dissatisfaction with the claim process and level of customer service you received. You also specifically mentioned that you were hung up on by the claim agent. We reviewed your entire account in detail and listened to the phone calls, we were unable to locate a phone call where the claim agent disconnected the call.  Phone calls were reviewed from June 1, 2022, prior to 12:30pm PST, when you had first notified us of the customer service issue. We were able to find notes in the account that mentioned a call was possibly disconnected, and while listening to the call, there was an instance where poor connection was discovered. We sincerely apologize for this misunderstanding.
  

  On the morning of June 1, 2022, you reached out to Healthy Paws to request a direct payment to your hospital for services for your pet, Bella, who was currently being treated for an illness. A case was made for our Direct Payment team by the ************* team member you spoke with to review your request.
  

  After receiving the case, the Direct Payment team sent an email correspondence to you to discuss the direct payment process and what information was still required in order to proceed with your request. This included a copy of the itemized estimate from the clinic that will be performing your pets procedure or treatment, as well as updated medical records pertaining to the procedure or treatment. Once received, the documents would be reviewed by a manager for approval. Then, the clinic would be contacted to confirm that a direct payment would be accepted by them.
  

  An estimate of services and medical records were received from *************************** around 12:00 pm the same day. The Direct Payment team contacted the clinic after receiving the required documentation to confirm a direct payment would be authorized with the clinic. The clinic staff told them the office manager was not available but would return their call. Having received no return call, the Direct Payment team called the clinic the following morning, on June 2, 2022, and left another message with the clinic. Later that morning, another call was placed to the clinic and *************************** was able to give authorization for a direct payment, sending over the finalized invoice for review.
  

  On June 2, 2022, an invoice was received for a visit dated June 1, 2022, with a total invoice amount of $903.43. claim number 259073-1-9 was assigned. The claim was adjudicated and approved for a direct payment to the clinic for a total amount of $624.48, calculated as follows: the total covered amount of $800.56, minus your 10% coinsurance of $80.06, minus your remaining annual deductible of $96.02, for a total reimbursement of $624.48. The excluded items on the invoice included the Examination Fee for $55.83 and Pet Diet for $47.04.
  

  Please note that Direct Payments are typically requested in advance to ensure that the clinic accepts Direct Payments from pet insurance companies and that the condition is eligible for coverage. Direct Payments are time intensive to set up, review and approve.
  

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

  
  

• Initial Complaint

  06/01/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have paid them 47 per month for insurance since December 2020.I have filed my first claim within the last two months and When I call in everything is fine.Then I get an email that is totally different.This is on a claim for 906 claim from April 18th. Last email at 3 pm assigned case number and at 4 pm denied and stated opened too long/missing documents.

  

  Business response

  06/10/2022

  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 June 1, 2022, regarding the adjudication of claim number 1002957-1-1.  The claim was closed due to missing documentation and the length of time it had been open. 
  
  On April 20, 2022, Healthy Paws received a claim submission for a visit on April 18, 2022, for a dental procedure and mass removal. The total invoice amount was $906.43. Claim number 1002957-1-1 was assigned. As this was Meris first claim submission, complete medical records, including the required enrollment examination were required. Multiple requests for these documents were sent to you between the dates of April 20, 2022, and May 12, 2022. Complete medical records are crucial in providing us with a history of your pets past medical conditions, illnesses, and/or veterinarian services.  This allows Healthy Paws to identify any pre-existing condition(s) that would be excluded from coverage under your policy and to determine coverage for any new condition. 
  
  On April 28, 2022, medical records were received from ****************************** dated February 25, 2021, to April 21, 2022. On May 10, 2022, duplicate medical records were received from ******************************. On May 12, 2022, a Claims Adjuster reviewed the documents on file, but was unable to decipher exact details due to invoice illegibility. An email requesting a legible copy was sent to your clinic and was received the following day. On May 26, 2022, you reached out to Healthy Paws regarding your claim submission, and the claim was opened for review. On May 31, 2022, the claim was reviewed by a Senior Claims Adjuster. It was noted that medical records were incomplete as documents for all visits prior to February 25, 2021, including the required enrollment examination were still needed. Claim number 1002957-1-1 was closed due to missing documentation and the length of time it had been opened.
  

  Under Section II, the Claims Process Endorsement of your Policy reads as follows:
  5) LIMITATIONS
  a)    A pet less than six (6) years of age on the date of enrollment must have undergone a complete clinical examination. The exam must have taken place either in the twelve (12) months prior to the pet policy effective date, or within fifteen (15) days following the pet policy effective date.
  b)    A pet six (6) years of age or greater on the date of enrollment must have undergone a complete clinical examination within thirty (30) days prior to the pet policy effective date, or within fifteen (15) days following the pet policy effective date.
  c)    If you fail to submit your pet to a complete clinical examination, we will not pay for any medically necessary veterinary treatment provided to your pet until such time as your pet has undergone such examination. Subsequent to undergoing such examination, any costs for medically necessary veterinary treatment will be paid subject to all the terms and conditions of this policy.
  d)    When you submit a claim, we may ask you to provide the written record of the enrollment examination that you, when you applied for this insurance, represented as having taken place within the applicable periods outlined in paragraphs a. and b. above.
  e)    If you provide such record, we will process your claim, subject to the terms and conditions of this policy provided there are no pre-existing conditions related to that claim. If there are pre-existing conditions related to the claim, your claim will not be processed because this policy does not cover pre-existing conditions.
  f)     If you do not provide such record, the last day of the waiting period will be the later of:
        1. the last day of the longest applicable waiting period outlined in II. EXCLUSIONS & LIMITATIONS 1) b., 1) c., and 1) d.; or
        2. the date when the clinical examination was conducted for the conditions covered by this policy that resulted in your claim; and,
        your claim will not be processed because this policy does not cover illness or injury that occurs during the waiting periods outlined in II. EXCLUSIONS & LIMITATIONS 1) b., 1) c., and 1) d.
  

  Under Section V, DEFINITIONS, 2) Clinical Examination is deleted and replaced with the following:
  V. DEFINITIONS
  2) Clinical Examination. A thorough examination performed by a licensed and registered veterinarian encompassing all body systems of the pet that is documented in a written veterinarian record. Examination can also be referred to as full physical, physical consultation, full examination or veterinary examination.
  
  3) Enrollment Exam. A clinical examination having taken place within the applicable periods outlined in II. EXCLUSIONS & LIMITATIONS 5) a. and 5) b.
  

  Under section III, your policy reads as follows:
  

  10) In order to process a claim, you must allow us to contact your present and previous veterinarian(s) and provide us with the necessary authority to obtain any information we may require. In the event information relating to the history of the pet is missing or incomplete, the claim will not be processed. You must also agree to submit the pet to examination, if we require, by a veterinarian selected by us.
  

  On June 1, 2022, a Senior Claims Adjuster reviewed your account and determined that the claim was closed correctly. To adjudicate your claim, we still require full medical records with doctor notes prior to February 25, 2021, including your pets required enrollment examination. Additional medical records can be sent to ************************************.
  

  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

  05/27/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In the late summer of 2021 I purchased pet insurance for my dog, Moko, from this company. In late October my dog had cherry eye surgery at a cost of approximately $600+. I submitted the claim but never heard from them via email. Only much later I found out they sometimes message you on-line only. I had submitted everything I had from the vet. I did not receive payment. In early 2022 my dog developed a serious eye ulcer. He was seen by the primary vet plus ER vets and had specialized surgery. All of this was approximately$5,000+ . Documentation was submitted multiple times as they requested more information. No emails received and only online cryptic messages that said they needed more information or they felt something was not submitted. No payment for any of the invoices.I finally received an email that said that they thought I might be wanting to appeal their decision. I have no idea what their decision was as on line it only said 'closed'. I sent all of the documention for the ulcer sergery to the email they said they wanted the appeal to go to. It has been over a month with no communication at all either via email or online.My policy cover 80%. I do not see how these surgeries could not be covered. I have never received any explaination for not covering anything.Note on the invoices you will see my name as well as one of my parents who had to take Moko while I was at work. The first page of Moke Cherry Eye is a duplicate page.

  

  Business response

  06/06/2022

  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 27, 2022, regarding the adjudication of claim number 1088858-1-1 through 1088858-1-11.  The claims were closed due to missing documentation and the length of time they had been open.
  
  ***** policy effective date was September 22, 2021, and the 15-day waiting period ended on October 7, 2021.
  

  On November 16, 2021, Healthy Paws received a claim submission for a visit on October 21, 2021, for a cherry eye procedure, in the amount of $594.00.  Claim number 1088858-1-1 was assigned.  Multiple email requests for complete medical records were sent to you between November 17, 2021, and December 8, 2021, in order to adjudicate your claim. A request for medical records was also sent to your veterinary clinic on November 17, 2021.    On November 28, 2021, you sent in medical records which included Patient Vaccination Forms from The Pet Stop dated September 11, 2021, and 2 other visits which were unreadable. These records did not include the required enrollment examination information. An additional invoice, without doctor notes, was included from ************************** dated September 16, 2021, for a corneal eye staining. You also sent an estimate for a cherry eye procedure from **************************, dated September 23, 2021, which is during your pets 15-day waiting period. Healthy Paws is unable to provide coverage for any clinical symptoms or conditions if they first occur or displayed symptoms prior to the pet policy effective date or during any applicable waiting periods, as stated in the policy. Therefore, the visit on September 16, 2021, and the estimate of services on September 23, 2021, would not be eligible for coverage. The claim was closed on December 28, 2021, due to missing medical records and the length of time the claim had been opened.  Full medical with doctor notes from **************************, including your pets required enrollment examination, were needed to adjudicate your claim.
  

  On March 12, 2022, Healthy Paws received multiple claim submissions for the treatment of a corneal ulcer and cherry eye, including diagnostics and follow-up care. The following claim numbers were assigned: Claim number 1088858-1-2, for a visit on February 19, 2022, and a total invoice amount of $5,248.73. Claim number 1088858-1-3, for a visit on February 17, 2022, and a total invoice amount of $570.58.  Claim number 1088858-1-4, for a visit on February 25, 2022, and a total invoice amount of $71.00.  Claim number 1088858-1-5, for a visit on February 16, 2022, and a total invoice amount of $172.47.  Claim number 1088858-1-6, for a visit on February 16, 2022, and a total invoice amount of $404.00.  Claim number 1088858-1-7, for a visit on February 15, 2022, and a total invoice amount of $29.84. Claim number 1088858-1-8, for a visit on February 10, 2022, and a total invoice amount of $170.77.  Claim number 1088858-1-9, for a visit on November 15, 2021, and a total invoice amount of $30.00.  Claim number 1088858-1-10, for a visit on October 21, 2021, and a total invoice amount of $594.00. 
  

  Multiple email requests for complete medical records were sent to you between March 13, 2022, and April 3, 2022. On March 12, 2022, line-item medical records, which are missing the doctor notes, were received from ************************** dated September 16, 2021, to February 15, 2022. On March 14, 2022, medical records were received from BluePearl Specialty & ****************** dated February 17, 2022, to February 18, 2022. Medical records with doctor notes were still missing from **************************, as well as ***************************** *********** On April 14, 2022, claim numbers 1088858-1-2 through 1088858-1-10 were closed due to missing documentation and the length of time they had been open.
  

  On April 18, 2022, Healthy Paws received a duplicate claim submission for a visit on February 16, 2022, for eye treatment and medication, with a total invoice amount of $404.00. Claim number 10888585-1-11 was assigned. The claim was adjudicated the same day and denied as a duplicate claim. This claim had previously been processed and closed in claim number 1088858-1-6, which was needing additional medical records in order to be adjudicated, as noted above.
  

  Under Section II, the Claims Process Endorsement of your Policy reads as follows:
  5) LIMITATIONS
  a)    A pet less than six (6) years of age on the date of enrollment must have undergone a complete clinical examination. The exam must have taken place either in the twelve (12) months prior to the pet policy effective date, or within fifteen (15) days following the pet policy effective date.
  b)    A pet six (6) years of age or greater on the date of enrollment must have undergone a complete clinical examination within thirty (30) days prior to the pet policy effective date, or within fifteen (15) days following the pet policy effective date.
  c)    If you fail to submit your pet to a complete clinical examination, we will not pay for any medically necessary veterinary treatment provided to your pet until such time as your pet has undergone such examination. Subsequent to undergoing such examination, any costs for medically necessary veterinary treatment will be paid subject to all the terms and conditions of this policy.
  d)    When you submit a claim, we may ask you to provide the written record of the enrollment examination that you, when you applied for this insurance, represented as having taken place within the applicable periods outlined in paragraphs a. and b. above.
  e)    If you provide such record, we will process your claim, subject to the terms and conditions of this policy provided there are no pre-existing conditions related to that claim. If there are pre-existing conditions related to the claim, your claim will not be processed because this policy does not cover pre-existing conditions.
  f)     If you do not provide such record, the last day of the waiting period will be the later of:
        1. the last day of the longest applicable waiting period outlined in II.               EXCLUSIONS & LIMITATIONS 1) b., 1) c., and 1) d.; or
        2. the date when the clinical examination was conducted for the         conditions covered by this policy that resulted in your claim; and,
        your claim will not be processed because this policy does not cover    illness or injury that occurs during the waiting periods outlined             in II. EXCLUSIONS & LIMITATIONS 1) b., 1) c., and 1) d.
  

  Under Section V, DEFINITIONS, 2) Clinical Examination is deleted and replaced with the following:

  V. DEFINITIONS

  2) Clinical Examination. A thorough examination performed by a licensed and registered veterinarian encompassing all body systems of the pet that is documented in a written veterinarian record. Examination can also be referred to as full physical, physical consultation, full examination or veterinary examination.
  3) Enrollment Exam. A clinical examination having taken place within the applicable periods outlined in II. EXCLUSIONS & LIMITATIONS 5) a. and 5) b.
  Under section III, your policy reads as follows:
  10) In order to process a claim, you must allow us to contact your present and previous veterinarian(s) and provide us with the necessary authority to obtain any information we may require. In the event information relating to the history of the pet is missing or incomplete, the claim will not be processed. You must also agree to submit the pet to examination, if we require, by a veterinarian selected by us.
  

  On May 2, 2022, Healthy Paws reached out to you and provided a complete breakdown of all your claim submissions, why they were closed without payment, and included an explanation as to what we were still needing to reprocess your claims. Additional requests were sent to your clinic for examination notes. However, nothing further has been received at this time.
  

  On May 31, 2022, a Senior Claim Adjuster reviewed the claim submission and determined they were correctly adjudicated.  Medical records with doctor notes are still needed to correctly adjudicate the claims. Medical records with doctor notes from **************************, as well as ***************************** *********** can be sent to ************************************.
  
  Healthy Paws provides automated messaging through the customer center online to notify you when a claim has been received and is under review, or that a claim may need your attention. You can also view a copy of your Explanation of Benefits once a claim is completed. However, emails are also sent to the primary email address on file which includes more detailed information. If the email address we have on file for you needs to be updated, you are welcome to reach out to us or update this in your customer center online.
  
  ******************** 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

  06/08/2022

   
  Complaint: 17284643
  
  I am rejecting this response because:
  
  Sincerely,
  
  *********************

   

  I have contacted the original vet through The Pet Stop that that was used by the breeder to get the needed examination records.  This information will document the examination.  The puppy was owned by the Breader at that time.  As the Breader was the owner at the time, I did not have this information currently.  The ulser was not a preexisting issue and was of unknown cause.  This ulcer occurred several months after the original cherry eye surgery.  

   

  The response from the company is the most information I've received the entire time I have had this insurance.  I had no idea that they wanted an initial exam or I would have provided it to them months ago.  None of their communication to me through the claims process asked for this information.  I am officially diagnosed Dyslexic.  Because of this it is extremely difficult for me to read printed words.  I will often miss information due to this disability. Additionally, during this time I was hospitalized and had surgery to deal with a ruptured spleen.  I was not able to handle any personal business for several weeks.   If I had receive clearer information other than something like 'needs help', I would have been able to comply.

  I filed this complaint due to reading several others who have had similar things happen and only with the BBB assistance was there a positive resolution for the pet owner.

• Initial Complaint

  05/23/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I signed up for a policy on 2/4/22 and sent in the vet records the very same day.I filed for my first claim on 5/4/22 for my cat who was diagnosed with asthma on 4/29/22. First of all, it took three weeks to get a response, which during this time I was asked for my vet records FIVE TIMES. I had already sent in the vet records on 2/4/22! I sent them in each time they asked for them too. They also sent me confirmation of another person's pets records being received during this time. I emailed multiple times when they asked for the records, as I had already sent them every single time they asked for them! No one ever responded and I had to call multiple times to make sure they were received. On 5/23/22 I was denied for a pre-existing condition due to a vet visit on 7/7/22. The condition (asthma) was DISCUSSED with the vet as I had concerns. IT WAS NOT DIAGNOSED. The records CLEARLY STATE (pg 14) that the Diagnosis is "GOOD" and the x-rays came back clear. My pet was not diagnosed with asthma until 4/29/22 which was WELL WITHIN the terms of the insurance being valid and the whole reason why I filed the claim. I called and the rep told me it was denied due to page 16 - which was the vet visit on 4/29/22! Again, the entire reason why the claim was filed to begin with. My vet is also sending in a letter stating that my cat's condition was GOOD on 7/7/22.I have responded to the claim and filed an appeal, however I do not trust this company to make good on their promises as they can't even respond to emails and can't hold on to the records sent multiple times.

  

  Business response

  05/26/2022

  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, 2022 regarding the adjudication of claim number 1126286-1-1.  The claim was denied due to the policys pre-existing conditions exclusion.
  
  Caesars policy effective date was on February 5, 2022, and his 15-day waiting period ended on February 20, 2022. 
  

  On May 4, 2022, Healthy Paws received a claim submission for a visit on April 29, 2022 for an exam fee and bloodwork in the amount of $310.00. Claim number 1126286-1-1 was assigned. On May 12, 2022, a request for complete medical records was sent to you and your clinic. Prior to receiving your claim, Healthy Paws had received medical records from ************************ dated September 24, 2019 and December 19, 2019, as well as medical records from Animal House of ******* dated July 7, 2021. On May 12, 2022, you submitted additional medical records for the visit on April 29, 2022, from Animal House of *******.
  

  Automated emails are sent out when a claim is missing documentation to provide pet parents the information thats needed to adjudicate a claim. Even when documentation is received, the emails will continue to go out until it has been reviewed by a Senior Claims Adjuster, and the claim has been manually updated. 
  

  Claim number 1126286-1-1 was reviewed on May 23, 2022 by a Senior Claims Adjuster and denied due to the Policys pre-existing exclusion. On July 7, 2021, prior to the policy effective date, Caesar was evaluated for having coughing fits on and off for one (1) year. He was also noted to occasionally pant after exercise. The veterinarian discussed asthma, allergies, testing for heartworm disease, and a Cardiology Consultation with you. A suggestion to monitor episodes for worsening was noted. 
  

  Caesar was evaluated on April 29, 2022, for coughing episodes and hard swallowing two (2) days prior to the visit. Asthma was suspected. As Caesars coughing episodes were originally noted prior to enrollment examination dated July 7, 2021, Healthy Paws is unable to provide coverage for this. Please note that coverage is not based on a diagnosis, it is based on when clinical signs and symptoms first presented.  
  

  Please refer to your Policy Section II, subsection 2), which states as follows: 
  II. EXCLUSIONS & LIMITATIONS 
  2) PRE-EXISTING CONDITIONS
  We do not cover pre-existing conditions. 
  
  4) OTHER EXCLUSIONS
  We do not reimburse the costs, fees or expenses associated with:
  h. Abnormalities where clinical symptoms were apparent prior to the pet policy effective date. This includes conditions that are detectable by a routine physical exam by your veterinarian. 
  
  V.DEFINITIONS
  3) Clinical Symptoms. Any manifested anomaly in, or deviation from the regular healthy state or function of a pet, including behavioral traits. Clinical Symptoms include any anomaly that is readily detectible by a thorough and complete clinical examination. 
  
  5) Condition. Any manifestations of clinical symptoms consistent with a diagnosis or diagnoses, regardless of the number of such symptoms or areas of the body affected.
  
  24) Pre-existing condition means: 
  a. Illness or condition which developed or redeveloped prior to the pet policy effective date; 
  b. an injury, or recurrence of an injury, as a result of an accident that occurred prior to the pet policy effective date; or 
  c. any condition or complication resulting from an illness that developed, or any injury as a result of an accident that occurred prior to the pet policy effective date.
  

  On May 23, 2022, you reached out to Healthy Paws to request an appeal of claim number 1126286-1-1. You advised us via correspondence that Caesar was not diagnosed with Asthma on July 7, 2021, but on April 29, 2022 after the policy was in place. On May 24, 2022, your request was reviewed by the appeals team. The appeal was denied as the clinical symptoms of coughing were noted to be present a year prior to the visit on July 7, 2021. Asthma was a possible cause of the coughing as discussed by your veterinarian during the visit on July 7, 2021. Coughing was again present during the visit on April 29, 2022 with suspected asthma noted as the cause. 
  

  For clarification, medical records were received for Caesar on May 12, 2022 from Animal House of ******* for dates spanning September 24, 2019 to April 30, 2022. Confirmation was originally sent referencing the incorrect clinic of ************************. Please accept our apologies for this oversight. 
  

  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

  05/30/2022

   
  Complaint: 17246308
  
  I am rejecting this response because: Caesar was NOT diagnosed and was given a clear **** of health on the visit in July. There is NO notes stating that asthma was the cause of his coughing as his X-rays were CLEAR. The vet will be sending a statement saying this as well. A preexisting condition must be DIAGNOSED and it was NOT. The records CLEARLY state he was I. Good health and I was the one who mentioned asthma NOT THE VET.
  
  Sincerely,
  
  *******************************

• Initial Complaint

  05/11/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Healthy Paws Policy # I09449802 Healthy Paws Case #******** Claims: #*********************-1-114, #******-1-115, #******-1-116, #******-1-117, #******-1-118, #******-1-119, #******-1-120, #******-1-121, #******-1-122, #******-1-123, #******-1-124, #******-1-125 These claims are for the policy year 2021 and were submitted for reimbursement on March 19, 2022 and April 12, 2022.ISSUE:My deductible and reimbursement percentage for 2021 was $250 / 90%, which is how the reimbursement for these claims should have been calculated. However, the reimbursement was calculated using the new deductible and reimbursement percentage, which I changed to $500 / 80% for the 2022 policy year. These claims total $692.72 but I have been reimbursed only $153.58. I am still owed $539.14.I have spoken to several Healthy Paws representatives. I am told that my case has to wait in line and, to date, I have not been given an ETA for these reimbursements. It has been over 7 weeks. No further status has been communicated to me by Healthy Paws, written or otherwise, and I continue to pay the monthly premium with no resolution in sight.

  

  Business response

  05/20/2022

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of ACE American Insurance Company, is responding to your communication to the Better Business Bureau dated May 11, 2022, regarding the processing of claim numbers ************ through ************ and the application of your reimbursement percentage and deductible.
  

  On February 11, 2022, you inquired about changing Desirees coverage levels. You updated Desirees reimbursement level from 90% to 80% and her annual deductible level from $250 to $500, which became effective on March 20, 2022. Upon the completion of claim numbers ************ through ************ which were processed after the change took effect, you reached out to Healthy Paws to let us know that the wrong deductible and reimbursement level were applied to the claims. The invoice dates submitted were all prior to the March 20, 2022, effective date.  A case was sent to our technical team to research and correct this for you. 
  

  The technical team was able to determine the cause of the problem and claim numbers ************ through ************ were reset and reprocessed with the correct reimbursement and deductible applied. 
  

  As payment was previously sent to you for claim numbers **************************, and ************, these claims were unable to be reset and reprocessed. Instead, they were appealed for reimbursement owed under claim numbers **************************, and ************ respectively. A complete explanation for each claim reimbursement was provided to you in your claims completed email. The additional reimbursement for these claims will be submitted to you via check. 
  

  Please see the following claims calculations, which have been reprocessed and/or appealed at the corrected reimbursement and deductible amounts. 
  

  Claim number ************: 
  Total Invoice amount= $37.90. Total Covered: $37.90 minus your 10% coinsurance=$34.11. This was applied towards your annual deductible.
  

  Claim number ************: 
  Total Invoice amount=$50.20. Total Covered: $50.20 minus your 10% coinsurance=$45.18. This was applied towards your annual deductible.
  

  Claim number ************: 
  Total Invoice amount=$4.50. Total Covered: $4.50 minus your 10% coinsurance=$4.05. This was applied towards your annual deductible.
  

  Claim number ************: 
  Total Invoice amount=$10.49. Total Covered: $10.49 minus your 10% coinsurance=$9.44. This was applied towards your annual deductible.
  

  Claim number ************: 
  Total Invoice amount=$15.89. Total Covered: $15.89 minus your 10% coinsurance=$14.30. This was applied towards your annual deductible.
  

  Claim number ************: 
  Total Invoice amount=$144.00. Total Covered: $144.00 minus your 10% coinsurance=$129.60. This was applied towards the remainder of your annual deductible and approved for reimbursement in the amount of $86.08 
  

  Claim number ************: 
  Total Invoice amount= $137.62 minus the Total Exclusions of $67.00= Total Covered: $70.62. $70.62 minus your 10% coinsurance=$63.56 approved for reimbursement. 
  

  Claim number ************: 
  Total Invoice amount= $52.60. Total Covered: $52.60 minus your 10% coinsurance=$47.34 approved for reimbursement.
  

  Claim number ************: 
  Total Invoice amount= $52.60. Total Covered: $52.60 minus your 10% coinsurance=$47.34 approved for reimbursement.
  

  Claim number ************: 
  Total Invoice amount= $50.20. Total Covered: $50.20 minus your 10% coinsurance=$45.18 approved for reimbursement.
  

  Claim number ************:  No Change to This Claim
  Total Invoice amount= $32.72. Total Covered: $32.72 minus the 20% coinsurance=$26.18, minus a deductible amount of $9.40, for a total reimbursement of $16.78. 
  

  Claim number ************: No Change to This Claim 
  Total Invoice amount= $51.00. Total Covered: $51.00 minus the 20% coinsurance=$40.80 approved for reimbursement.
  

  Claim number ************: No Change to This Claim
  Total Invoice amount= $120.00. Total Covered: $120.00 minus the 20% coinsurance=$96.00 approved for reimbursement.
  

  Claim number ************ (Adjudicated claim number ************): 
  Corrected claim shows Total Invoice: $32.72. Total Covered: $32.72 minus 10% coinsurance=$29.45. $16.78 was already reimbursed in claim number ************. An additional $12.67 was provided in payment on this claim for a total of $29.45 in reimbursement. 
  

  Claim number ************ (Adjudicated claim number ************): 
  Corrected claim shows Total Invoice: $51.00. Total Covered: $51.00 minus 10% coinsurance=$45.90. $40.80 was already reimbursed in claim number ************. An additional $5.10 was provided in payment on this claim for a total of $45.90 in reimbursement.
  

  Claim number ************ (Adjudicated claim number ************): 
  Corrected claim shows Total Invoice: $120.00. Total Covered: $120.00 minus 10% coinsurance=$108.00. $96.00 was already reimbursed in claim number ************. An additional $12.00 was provided in payment on this claim for a total of $108.00 in reimbursement.
  

  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

  05/20/2022

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that Healthy Paws finally did recalculate and settle these claims but ONLY THE *** AFTER I FILED MY COMPLAINT WITH THE BETTER BUSINESS BUREAU. Prior to that Healthy Paws would not commit to a resolution for the eight weeks since I submitted these claims. During that time I sent an email to the *** and a written letter to the ** of Claims, but I never heard back from either one. It was the BBB that lit a fire under this company.
  

  I have cancelled my policy as I will not do business with a company that blows off its customers while they drag their feet figuring out THEIR mistakes. I will post online reviews about my experience accordingly.

  BBB, thank you for your assistance in this matter.
  
  Sincerely,
  
  *************************

• Initial Complaint

  05/05/2022

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  I have submitted several claims for my pet's veterinary bills and have not received any reimbursement. When I spoke with the company they claimed they didn't have any records. My vet sent them the invoices several times. I know there was a deductible, but that was met and I recently had a $2,000 surgery for her and have not even received an acknowlegement for that claim. I know it has been sent to them and have it resent a few times.My pet's name is: ****************************** and her number is: *******

  

  Business response

  05/16/2022

  
  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 5, 2022, regarding the processing and handling of your claims for your pet, *******. 
  
  Healthy Paws received six (6) claim submissions via e-mail for dates spanning from January 1, 2022, to February 12, 2022.  The claims were adjudicated on February 23, 2022, after complete medical records were received from you and your veterinarian clinic.
  
  On April 20, 2022, you reached out to Healthy Paws inquiring about the receipt of invoices for dates after February 12, 2022. You were advised that Healthy Paws had not yet received these invoices. Later that morning, our ************* Team confirmed receipt of the invoices from both you and your clinic. The invoices were opened for adjudication on April 20, 2022 under claim numbers 1088039-1-7 through 1088039-1-12.
  
  Please note that claim number 1088039-1-10 for a visit on March 24, 2022, for a total invoice amount of $212.69, was waiting on medical records.  The medical records were required to determine coverage for the specific line items on the invoice received. A request for medical records was sent to ************************** on April 25, 2022, and again on May 6, 2022. They were received on May 7, 2022, and your claim was adjudicated on May 9, 2022, along with claim numbers 1088039-1-11 and 1088039-1-12.
  
  Regarding your inquiry about Camilles invoice for surgery, the invoice dated February 25, 2022, for a total invoice amount of $2,229.57 was received on April 20, 2022. It was assigned claim number 1088039-1-12. Acknowledgment of receipt for this invoice was sent to you on April 20, 2022.
  
  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.
  

*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. ↩