ComplaintsforHealthy Paws

• Initial Complaint

  12/14/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  This is now be my FOURTH writing regarding the licensee. The licensee pattern and practice of insurance bad faith involving the licensee refusal to pay a claim without a reasonable basis or without proper investigating the claim in a timely manner. The licensee had a duty to pay a judgment up to the policy limits when a loss is covered by the policy. On or about December 13, 2021 I had submitted a claim electronically using a website the licensee promotes for this purpose of reimbursement for canine medical treatment. The same medical treatment have been reimbursed by the licensee in the past. The licensee had completed reimbursement regarding the same care on or about the following treatment dates: Tuesday, December 6th 2021 The licensee denies a claim for the treatment on or about December 13, 2021. The licensee accepted a similar invoice submitted electronically for past canine medical treatment. This canine medical treatment is identical. The licensee shall cease bad faith practices and review documents submitted by the complaint and other residents of the state of Wisconsin whom conduct business with the licensee according to the licensee pet health insurance policy and complete the adjusted reimbursement. Past complaints did compel the Licensee to correct a Wisconsin addendum with correct contact information sufficient to resolve complaints.

  

  Business response

  12/23/2021

  Healthy Paws Pet Insurance, LLC (“Healthy Paws”), the managing general underwriter on behalf of ********* ********* ******* ** ***** *******, is responding to your communication to the Better Business Bureau dated December 14, 2021, regarding claim number ******-1-136.  The claim was placed into a missing information status due to the pet name missing on the invoice but has since been processed.
  
  On December 13, 2021, Healthy Paws received a claim submission for the same date of service for a swim session, in the amount of $28.38. The claim was assigned claim number ******-1-136. When the invoice was reviewed by the original claims adjuster, it was noted that there was no pet name on the invoice. As this is typically a standard requirement in processing a claim, the claim was changed to a waiting for information status for the Senior Claims Adjuster to review.
  
  On December 14, 2021, the Senior Claims Adjuster assigned to process your claims reviewed the claim and made note that this particular clinic does not include pet names on their invoices. The claim was processed and approved the same day in the amount of $14.70, and applied towards your annual deductible, calculated as follows: the total covered amount of $18.38, minus your 20% coinsurance of $3.68, which equals $14.70, and applied towards your pet’s $250.00 annual deductible.
  
  Regarding claim number ******-1-134, the Senior Claims Adjuster had more familiarity with this clinic and its invoices and was able to determine that additional information was not needed. It was adjudicated the day after the claim was submitted. 
  
  Please note that per the Policy, Section III., General Conditions, 9) The loss is payable within sixty days after completion of the claim form, unless applicable state law provides for a shorter period.  In review of your claims history, the 183 claims filed with Healthy Paws have been adjudicated in an average of 2.45 days. 
  
  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.

  ***ALL SUPPORTING DOCUMENTATION REDACTED BY BBB***
  

  Customer response

  12/28/2021

  
  Better Business Bureau:
  
  I accept this business response regarding BBB complaint #********. and wish to close at this time.
  
  I accept that the business response regarding BBB complaint #********. contains information that supports Licensee produced policies underwritten was exclusively by *** from January 17, 2013 until June 17, 2016. From June 17, 2016 to present, the Licensee has been producing policies underwritten exclusively by *********.
  
  The business response regarding BBB complaint #********. supports that State of Wisconsin residents whom have policies underwritten exclusively by ********* ********* ******* ** ***** ******* did receive a correct addendum announcing the correct company (********* ********* ******* ** ***** ******* ) and contact information now sufficient to resolve complaints.  Past communication over the last three years regarding this deficiency was ignored by Healthy Paws Pet Insurance LLC. 
  
  Healthy Paws Pet Insurance LLC business practice included:
  Billing customers at rates not approved by the state
  Raising rates annually based on the pet's age, a factor the insurers had neither sought nor received approval to use
  Failing to provide customers the required 20-day notice of rate increases before the policy renewal date
  And;
  Incorrectly applying discounts: giving some policyholders fewer discounts than they qualified for, and giving discounts to other policyholders who didn't qualify
  
  
  This communication will be shared with Wisconsin Office of the Commissioner of Insurance, a state agency which enforces Wisconsin's insurance laws supporting a review of the insurers' market activities. 
  
  ****** ******

• Initial Complaint

  11/05/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Healthy Paws wrongfully cancelled policy #******-*. On 9/9/21 I submitted an invoice dated 9/8/21 as a claim for ******** via the Healthy Paws mobil app. She was the ONLY active pet in my portal. Healthy Paws mistakenly processed that claim for ****** (******-4-15) who has not been active since March 2020. On 9/9/21 at 4:41PM I emailed “[email protected]” to process that claim for ********. “Hello, ****** [last name] no longer has a policy. Rates were too high. Please process for ********. ******* [last name]”. On 9/9/21 I resubmitted the SAME invoice, thinking it to be a better solution than the previous e-mail. This time I crossed out ******’s name. The invoice was processed as claim ******-3-25, and I was reimbursed. On 10/21/2021 at 12:01PM I received an email that ********’s policy had been cancelled per my request as of 9/10/21 at 12:01AM. I did NOT cancel ********'s pet insurance. I have owned a policy since 2017, and I have never been late with a payment. I have met my deductible for this 2021 term.

  

  Business response

  11/11/2021

  Healthy Paws Pet Insurance, LLC (“Healthy Paws”), the managing general underwriter on behalf of *********** **** ********* *******, is responding to your communication to the Better Business Bureau dated November 5, 2021, regarding a cancellation discrepancy. 
  

  On September 9, 2021, an invoice was submitted for the date of service of September 8, 2021, which included charges for both ****** and ********. A claim was opened for ****** and assigned claim number ******-4-15. It was denied the same day, as ******’s policy was previously cancelled on May 3, 2020. 
  

  Upon receiving the claim denial for ****** on September 9, 2021, the claim was re-submitted with the same invoice indicating the claim was for ********. A claim was opened for ********, in the amount of $156.00. The claim was assigned claim number ******-3-25, and adjudicated on September 10, 2021, with a reimbursement of $108.80 to the payment method on file. 
  

  In addition to the claim submission, Healthy Paws received an e-mail indicating the following: “****** Olsen no longer has a policy. Rates were too high. Please process for ********.” 
  In reviewing your account, a Healthy Paws customer care team representative misinterpreted your e-mail as a request for cancellation of ********’s policy. The policy cancellation was processed with an effective date of September 10, 2021. 
  

  We apologize for this misunderstanding. The policy cancellation for ******** was voided and will be active pending the payments of premiums for September, October, and November in the amount of $258.24. You will receive the voided cancellation email shortly with instructions on how to pay your outstanding balance to reactivate ********'s policy with no interruption of coverage. 
  

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

  Thank you. 

  ***ALL SUPPORTING DOCUMENTATION REDACTED BY BBB***

  Customer response

  11/13/2021

  
  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

  09/23/2021

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  Dec 2020: I began paying Healthy Paws Pet Insurance (HPPI) a monthly premium of $16.84/mo to cover my cat. March 2021: I filed my first claim; it was denied because the baseline exam required to begin covering my cat occurred 14 months prior to signup rather than within 12 months. HPPI had not validated the baseline exam at time of my sign up. In essence, I’d been paying for no coverage/nothing at all the whole time. There were customer service back-and-forths through May 2021 - and I had been continuing to pay all the while. I requested a refund and was denied. My account has been canceled. I seek $101.04 which is the amount I’d paid December 2020 through May 2021 since it was an unenforceable contract and HPPI had acted in bad faith. HPPI had not provided any contractual consideration in exchange for my $101.04, nor had done any due diligence to ensure the baseline exam was qualifying at sign up (when I first started paying them). They shouldn’t be allowed to charge for nothing.

  

  Business response

  10/01/2021

  Healthy Paws Pet Insurance, LLC (“Healthy Paws”), the managing general underwriter on behalf of *********** **** ********* *******, is responding to your communication to the Better Business Bureau dated September 24, 2021, regarding a cancellation discrepancy.
  

  *********** **** ********* ******* issued your Pet Health Insurance Policy, Policy number *******-1, with an effective date of December 30, 2020, for ***, a domestic short haired feline. Healthy Paws is the managing general underwriter on behalf of *********** **** ********* *******.
  

  On March 28, 2021, Healthy Paws received a claim submission for an emergency visit dated March 23, 2021, for urinary issues, in the amount of $404.30. Complete medical records were requested, including your pet’s required enrollment clinical examination. On April 27, 2021, having failed to provide proper documentation for the required enrollment clinical examination, your claim was denied, using the emergency visit’s clinical examination as your pet’s enrollment clinical examination.
  

  Per the Claim Process Endorsement, effective December 30, 2020, under Section II, EXCLUSION AND LIMITATIONS, 5) Limitations, your Policy states 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) Your failure to submit your pet to a complete clinical examination may void the policy. If the policy is voided, the policy premium will be refunded.
  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, 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 &
  2. the date when the clinical examination 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.
  LIMITATIONS 1) b., 1) c., and 1) d.;

  Furthermore, under Section V, DEFINITIONS, subsection 2), the Clinical Examination is defined as follows:
  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.
  

  ***’s Policy became effective on December 30, 2020. In order to adjudicate claim number *******-1-1, Healthy Paws required a clinical examination of your pet dated between December 31, 2019, and January 14, 2021, per the policy. With no examination performed within this timeframe, Healthy Paws was left with the only option of using the earliest clinical examination on file after the policy effective date as the enrollment examination, in order to adjudicate your claim. Pursuant to our records, the earliest examination on file was performed on March 23, 2021.
  

  On May 13, 2021, you requested a full refund as we were unable to provide coverage for your claim due to the missing enrollment clinical examination. A Claims Liaison Manager reached out to you and attempted to obtain additional adoption records for *** in order to appeal your Claim. On July 13, 2021, adoption records and a neuter certificate were received dated between December 17, 2018 and January 19, 2019. However, none of the documents provided could be considered and used as the enrollment clinical exam necessary to adjudicate the claim, and the appeal of your claim was denied.
  

  On August 13, 2021, upon further discussions with you, a request to void the Policy was made. The request was subsequently denied due to the Policy Exclusions and Limitations, as outlined above. The first date you requested a cancellation was on March 14, 2021; as such, and in accordance with the terms of your Policy, the policy was cancelled effective March 15, 2021, at 12:01 am PST, the day following your initial request.
  

  However, a review of your account, indicates that in a correspondence dated August 13, 2021, a Claims Liaison Manager had implied that we would be able to provide you with a full refund of your premium. Since you were led to believe that a full refund was possible, despite the terms of your Policy, we will honor your request for a full premium refund. The additional amount due to you for a full refund is $75.78.
  

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

  Thank you.

   ***ALL SUPPORTING DOCUMENTATION REDACTED BY BBB***

  Customer response

  10/02/2021

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********.

  Per their own policy that HealthyPaws cites (clause 5a: “Your failure to submit your pet to a complete clinical examination may void the policy. If the policy is voided, the policy premium will be refunded.”), I was due a full policy refund in the first place! So I don’t know why they have been acting in bad faith this whole time trying to keep $75 from me. The policy should have been voided retroactively since HealthyPaws was not providing ANY service or coverage since the date I started paying (December 20, 2020). To me, this constitutes a legal issue that HealthyPaws is trying to skirt. I have consulted with an attorney and they agree that while I was not due coverage ever due to my own error - HealthyPaws was not due any money from me and should've refunded me in full to begin with.

  Additionally, see attached record. HealthyPaws refunded me starting in May 15, 2021 - rather than what they state in their response (March 2021). So their own account of the facts is incorrect. (According to their response, I should've been due $101.04 had I actually been refunded from March 2021 payment onward; I continued to be billed until August 2021.) Again, I believe this is an example of HealthyPaws trying to squeeze the lemon on a consumer - and distort the facts to the BBB.

  I want HealthyPaws to follow up with a written statement that covers: a) an apology to me, b) acceptance of responsibility that they should have refunded me in full due to the fact that they were not covering Tom for anything whatsoever (not providing any sort of service) in exchange for what I was paying them. With that written apology/statement, I accept the remaining full refund of $75.78 originally due to me and will consider the matter closed.

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

• Initial Complaint

  09/22/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  I have had my pets covered by Healthy Paws since we adopted them in 2014. This year when I filed a claim they requested our pets complete medical history. We had filed many claims in the past without this requirement. However, we provided the medical histories to the insurance company as requested. Now upon filing a 2nd claim they are stating they need our pet’s medical history again. This seems to be a way of delaying payment & trying to get people to give up getting paid claims. I send emails that are never responded to & they are closed during hours they say they are open for customer service. I am extremely disappointed by this company. I just want my claims processed as I submit them per our insurance policy.

  Customer response

  09/23/2021

  The company had paid both claims as of today. My complaint has been resolved. 
  
  *****
  

• Initial Complaint

  09/16/2021

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I filed a claim with my pet insurance, who covers 80% of my pet's prescriptions. I needed to provide the company, Healthy Paws Pet Insurance with a receipt from the pharmacy that dispensed this medication because they were wondering what type of medication was on the receipt listed as "Pet Rx". I provided a receipt of this, but they have been unresponsive and they are holding on to my money. They closed the claim, and they do not reply to me on e-mails. The insulin that I am looking to get my refund of costs $309.34, and they cover 80%. They owe me $247.872. I am unable to submit any more claims to them because every claim that I submit will never be responded to by them since they are asking for more documentation from this claim, despite the fact that I have e-mailed it to them, which I have records of.

  

  Business response

  09/24/2021

  Healthy Paws Pet Insurance, LLC (“Healthy Paws”), the managing general underwriter on behalf of ********* ********* ******* ** ***** *******, is responding to your communication to the Better Business Bureau dated September 16, 2021, regarding the processing of your claim.  Please be advised that once proper documentation necessary to adjudicate your claim was received on September 16, 2021, the claim was adjudicated and paid on September 17, 2021 in the amount of $263.46.
  

  On June 26, 2021, Healthy Paws received a claim submission for a prescription refill, which included a prescription slip from ********* dated June 24, 2021.  However, the submission was not complete as it was missing the prescription information.  On July 3, 2021, Healthy Paws received another claim submission which included a sales receipt from ********* dated June 26, 2021, for an unknown prescription and Insulin Syringes. On July 31, 2021, Healthy Paws received a third claim submission which included a duplicate copy of the prescription slip dated June 24, 2021, still missing the prescription information, and a printed receipt from ********* for a Pet prescription and Insulin Syringes, dated June 26, 2021.
  

  Multiple communications were sent to inform you that the information received was incomplete and that Healthy Paws was in need of a copy of the prescription showing what medication had been prescribed in order to move forward with the claims process.  After you submitted the requested documentations on September 16, 2021, Healthy Paws was able to proceed with the adjudication of your claim. 
  

  On September 17, 2021, your claim was adjudicated under claim number ******-1-226, and approved for reimbursement in the amount of $263.46, calculated as follows: the total covered amount of $329.33, minus your 20% coinsurance of $65.87, for a total reimbursement of $263.46.
  

  With regards to your current claim submission status, you submitted an additional eight (8) claims since June 26, 2021, which have all been adjudicated for you. 
  

  Your claim history shows that Healthy Paws has processed 216 of your 222 claims (97%) in less than 20 days.  While we strive to process all claims within thirty (30) days, it may take longer depending on when we receive the records.  Please also refer to your Policy, Section III. General Condition, subsection (9), which states as follows:
  
  Any loss is payable within sixty days after completion of the claim form, unless applicable state law provides a shorter period.
  
  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 further questions or concerns, please do not hesitate to contact us. 
  
  Thank you.

  ***ALL SUPPORTING DOCUMENTATION REDACTED BY BBB***
  

  Customer response

  09/26/2021

  
  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

  09/01/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been a customer of Healthy Paws for 5 years, since 5/3/2017. I submitted my first claim this August.My dog swallowed an object that was blocking her intestines. On 8/20/21 I provided the contact information for the only 2 vet visits my dog has had since I purchased her as a puppy on May 3, 2017. I confirmed the vet who she saw on 5/17/2021 faxed his records to healthy paws. I paid the hospital bill on 8/22/21 $9,688.36 and submitted my claim to healthy paws for reimbursement. On 8/30/21 I received email from Healthy Paws requesting “medical records prior to the claim visit.” I spoke to healthy paws on 8/30/21, explained vet had faxed them his records for 5/17/21 visit. They admitted they did receive vet records showing the 5/17/21 office visit & blood test done. I took my dog for a vet examination within the timeframe of my policy specifications and now they are denying my accident claim because the vet only has records showing the office visit & blood test, but he has no notes

  

  Business response

  09/13/2021

  Healthy Paws Pet Insurance, LLC (“Healthy Paws”), is in receipt of your recent inquiry as filed with the Better Business Bureau, on September 1, 2021, regarding the processing of claim number **********.  The claim was approved for payment on September 2, 2021 in the amount of $6,879.49.
  

  On August 23, 2021, Healthy Paws received a claim submission for an emergency visit, including an endoscopy and abdominal exploratory surgery for a foreign body, which took place on August 19, 2021, in the amount of $9,688.36, along with medical records for the visit.  Claim number ********** was assigned.  Medical records, including records prior to the August 19, 2021 visit, were requested in order to adjudicate your claim.  On August 25, 2021, Healthy Paws received blood work results from ***** ***** ****** ****** ****** dated November 25, 2019. On August 26, 2021, Healthy Paws received medical records from *** ******* ****** ****** dated May 17, 2017, which failed to include doctors’ notes.
  

  On September 1, 2021, you contacted Healthy Paws to inquire as to the reason your claim had not yet been processed. It was explained that we were still needing the doctors’ notes prior to the claim visit, which were not included in the documents received. You explained that the documents submitted from *** ******* ****** ****** had been archived and that there were no other records.  In addition, you reported that **** had only had 2 visits prior to the visit of August 19, 2021.
  

  On September 2, 2021, a Senior Claims Adjuster reviewed your claim and found the documentation to be sufficient since it was confirmed that the rest of the records from *** ******* ****** ****** had been archived and were no longer available.
  

  On September 2, 2021, claim number ********** was processed and approved for payment in the amount of $6,879.49, calculated as follows: the covered amount of $8,199.43, minus your 10% coinsurance of $819.94, which equals $7,379.49, applied towards your $500 annual deductible, for a total reimbursement of $6,879.49.
  Healthy Paws has handled the processing of your claim in good faith and in   accordance with all applicable laws and regulations.
  
  Should you have any further 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. ↩