ComplaintsforHealthy Paws

• 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,
  
  ***************************

• Initial Complaint

  05/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  As a long-time policyholder, I have submitted this same claim for reimbursement on 5 prior occasions with the same final, paid commercial invoice from the same provider and was successfully reimbursed 5 prior times. This 6th claim was denied for the erroneous reason that the document is an "Order Acknowledgment." ("Invoice" occurs twice on the document. "Order Acknowledgment" occurs zero times.) The commercial document is the final "Shipment Invoice" that is "released" when the patient pays ("Pat Pay"). Once the claim was erroneously denied, Healthy Paws was completely unresponsive. They did not respond to emails. When I called Customer Support, I received absolutely no support to resolve this matter. Instead, I learned that their "Customer Support" is some sort of cruel joke. I want to warn as many other potential policyholders as possible not to buy pet health insurance from Healthy Paws.

  

  Business response

  05/09/2024

  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 2, 2024, regarding the claim submission received on March 28, 2024 for your pet, Vantablack. The claim was processed and approved for reimbursement on May 6, 2024.
  
  On March 28, 2024, a claim submission was submitted which included a Shipment Invoice with a date of March 11, 2024, for the medication Leflunomide with a total invoice amount of $72.00. The same day, an email was sent to you acknowledging receipt of the Shipment Invoice for Vantablack. You were advised that upon receipt of a finalized invoice, the claim would be assigned a claim number, and we would move forward with the claims process. On April 2, 2024, you responded to the email, confirming that this was the final invoice. On April 8, 2024, you spoke with a customer service representative who verified that a finalized invoice was still needed as the invoice indicates this is a Shipment Invoice and not a finalized invoice.
  
  We recently discovered that some pharmacies provide Order Acknowledgment documents or shipping documents which can include different invoice numbers, dates of service, and sometimes different invoice totals than their finalized invoice. As a result, a finalized invoice is now requested for all submissions. This was thought to be the case with the claim submission from BCP Veterinary Pharmacy as the invoice said it was a Shipment Invoice. Therefore, a finalized invoice was requested. We understand you previously received payment with the Shipment Invoice and apologize for the confusion. Your previous claims were processed prior to this change being implemented.
  

  On May 6, 2024, Healthy Paws reviewed this matter pursuant to your May 2, 2024 inquiry. Additional variations of invoices from BCP Veterinary Pharmacy were found to be submitted by other Policyholders. These invoices included a Ship Date and/or a PAID stamp on it. BCP Veterinary Pharmacy was contacted, and it was confirmed that the invoice you had submitted was a finalized invoice. It was also confirmed that the other variations received were due to policyholders getting reprints of the invoice or picking up prescriptions directly from the pharmacy rather than having their medications shipped.  These invoices will be accepted as finalized invoices from this pharmacy moving forward.
  

  On May 6, 2024, the invoice dated March 11, 2024 was assigned claim number 740160-1-27. The claim was adjudicated and approved for reimbursement in the amount of $64.80, calculated as follows: the total covered amount of $72.00, minus your 10% coinsurance of $7.20, for a total reimbursement of $64.80.
  
  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

  04/29/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I am on SS and I get paid once a mo.I got paid on 4/22, took my dog to the Vet on 4/23, submitted all Docs to *********************************** on 4/24.Invoice $704.No claim initiated as of 4/29.When I called I was told no invoice was received but no one at HP claims told me.So, now SIX days later I emailed the invoice.As of afternoon, no claim # assigned.I have rent due on 6/1.I was told they process claims in the order received so for me it is 4/29, NOT 4/24.I have had nothing but problems with HP but my dog has pre-existing conditions so I cant switch to another Co,They REFUSED to give me the **************** Phone #.

  Customer response

  04/30/2024

  After multiple conversations, two at the Supervisor level, my claim was processed overnight, however this does not negate the contant battles that I have with Healthy Paws Pet Insurance everytime I submit a claim.

   

  

  Business response

  05/06/2024

  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 April 30, 2024, regarding the adjudication of claim number 439338-1-76.  As a preliminary matter, the claim was processed prior to the receipt of this complaint.
  

  On April 24, 2024, Healthy Paws received a medical records submission for ***** from ********************* spanning April 4, 2024, to April 24, 2024. The same day, Healthy Paws confirmed receipt of these records to you via email.
  

  On April 29, 2024, you called to inquire about a claim submission. You were advised that medical records were received and acknowledged via an email to you.  However, you were further advised that no invoice had been received indicating a loss therefore a claim submission on your end was requested. The same day, you called and spoke with a Customer Liaison Manager asking why you were not alerted to your claim not being received.  All claims that are formally submitted to Healthy Paws are acknowledged upon receipt with a confirmation email sent directly to the policyholder.
  

  On April 29, 2024, Healthy Paws received a claim submission for a visit on April 23, 2024, for diagnostic testing (bloodwork) for *****s gastrointestinal issues with a total invoice amount of $704.00. Claim number 439338-1-76 was assigned. The same day the claim was processed and approved for reimbursement in the amount of $633.60, calculated as follows: the total covered amount of $704.00, minus your pets 10% coinsurance of $70.40, for a total reimbursement of $633.60.
  

  Please understand that while we strive to process all claims within thirty (30) days, it may take longer depending on when we receive the records.  Furthermore, your Policy, Section III. General Condition, subsection 9) states as follows:
  

  The 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 questions or concerns, please do not hesitate to contact us. 
  
  Thank you.

  
  

• Initial Complaint

  04/29/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Super disappointed about the 75% rate increase in less than 1.5 years. I started a policy for my dog Kona right after adopting her in ********, *****. I cannot believe how a company can do this to clients who have been so loyal, not to mention that I haven't used the policy in over two years. I heard the babble from theri customer service/retention team that the claims experience for the collective book of business has not run well. I will never feel sorry for an insurance company (they always make money). It's sad that at the end of the day, this company and it's employees couldn't care less and feign compassion. I wonder how their employees would react if they received a 75% rate increase in less then 1.5 years on their health insurance premium. Would they just accept their brokers compassion and apology for the rising cost of their premiums? Bottom line is that my message will fall on deaf ears. Its all about money!!!!!!!!If your company doesn't make a HUGE profit then s**** the clients. Nothing can convince me otherwise. shaft.In addition, they never sent notice of renewal and I just happened to see that the new premium was pending on my bank statement. Since I am on automatic bank draft, this 37.8% rate increase is just debited from my account. They advised that they will credit my checking account, but it is the principle of increasing a policyholder this inane amount without their consent and ability to discuss beforehand.The clients always get the shaft and loyalty be damned!Regards,*************************************

  

  Business response

  05/03/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of ACE Property & Casualty Insurance Company (ACE), is responding to your communication to the Better Business Bureau dated April 29, 2024 regarding a premium increase for Pet Health Insurance Policy number I21813230.
  

  On February 27, 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 $100.93 which took effect on April 30, 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.
  

  On April 29, 2024, you called into our Customer Support Team and requested a cancellation of your policy. Your policy was canceled on April 30, 2024 at 12:01 AM Local Time per your request.
  

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

  Customer response

  05/03/2024

  Email was never received.  I checked my email inbox and also my spam and junk folder.  Doesn't it occur to this company that sending an email is not guaranteed to arrive to a client.  Where is the certainty of it being received?  ************ has countless negative reviews on the BBB site, and I am one of hundreds of disatasifed clients.  They can feign interest about caring for you as a pet parent, but that is bogus.  At the end of the day, it is a business and they are there to make money by inexoribatantaly raising members premiums to the point that they have to cancel.  They are probably not able to cancel a policy once it has been on the books for a few years, so they raise the premiums, making the policy unaffordable, and causing the client to voluntary cancel.  I haven't made claim in over 2 years and my policy gets raised 75% during that time.  They are not making what they deem a suitable profit and are raising rates at a ridiculos rate to make up for this discrepancy.  And I have already heard of the blabber that the whole block of business gets raised, and that it doesn't matter if one has never filed a claim. like a collective.  In my opinion, these are just plain talking points!!!!!!!!!

  This is not unique to this company.  The majority of insurance companies will raise rates.  However, they will be a little more reasonable and raise them 5-15% per year.  This rate increase is a travesty and the *** of this company should be ashamed that this is happening.  I wish that something gets done in the future so that the general population is protected from these predatory insurance companies and their rate increases. 

   

  At least I have a forum to state my grievances and educate potential clients to steer clear of this company.

   

  God Bless!

  Customer response

  05/03/2024

   
  Complaint: 21640127
  
  I am rejecting this response because Email was never received.  I checked my email inbox and also my spam and junk folder.  Doesn't it occur to this company that sending an email is not guaranteed to arrive to a client.  Where is the certainty of it being received?  ************ has countless negative reviews on the BBB site, and I am one of hundreds of disatasifed clients.  They can feign interest about caring for you as a pet parent, but that is bogus.  At the end of the day, it is a business and they are there to make money by inexoribatantly raising members premiums to the point that they have to cancel.  They are probably not able to cancel a policy once it has been on the books for a few years, so they raise the premiums, making the policy unaffordable, and causing the client to voluntary cancel.  I haven't made claim in over 2 years and my policy gets raised 75% during that time?

  They are probably not making what they deem a suitable profit and are raising rates at a ridiculos rate to make up for this discrepancy.  And I have already heard of the blabber that the whole block of business gets raised, and that it doesn't matter if one has never filed a claim. like a collective.  In my opinion, these are just plain talking points!!!!!!!!!
  This is not unique to this company.  The majority of insurance companies will raise rates.  However, they will be a little more reasonable and raise them 5-15% per year.  This rate increase is a travesty and the *** of this company should be ashamed that this is happening.  I wish that something gets done in the future so that the general population is protected from these predatory insurance companies and their rate increases. 
  
  At least I have a forum to state my grievances and educate potential clients to steer clear of this company.
  
  God Bless!
  
  Sincerely,
  
  *************************************

• Initial Complaint

  04/20/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  When I got my dog as a puppy, now 8, I took her for a puppy check and vaccines. Apparently the Veterinarian didnt do the SOAP notes. I have been paying for health insurance for my dog for 7 years now that she has a tore ligament they wont reimburse me because they say I didnt get a puppy check. I have paid every month on time. Now they wont honor that claim. Bad business!

  

  Business response

  04/29/2024

  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 April 20, 2024, regarding the adjudication of claim numbers 523832-1-1 and 523832-1-2.  The claims were denied pursuant to the policys Claims Process Endorsement, using the visit on February 2, 2024, to satisfy the required enrollment examination.
  
  On February 5, 2024, Healthy Paws received a claim submission for a visit on February 2, 2024, for diagnostics and treatment of a cruciate ligament injury with an invoice total of $602.06 Claim number 523832-1-1 was assigned. A request for complete medical records with doctors notes was sent to you and your veterinarian between February 6, 2024 and April 17, 2024. On February 7, 2024, a line-item medical history was received from ******** SPCA dated March 13, 2017. These records were missing the doctors notes from the visit. On February 12, 2024, medical records were received from Firehouse ********** spanning February 2, 2024 to February 6, 2024. On February 14, 2024, it was explained to you during a phone call that we were still in need of doctors notes from Tamzens required enrollment examination between October 24, 2016 and November 8, 2017. On February 21, 2024, duplicate line-item medical records were received from ******** SPCA dated March 13, 2017. On February 22, 2024, you confirmed with Healthy Paws that Tamzen was not evaluated by another vet aside from the visit on March 13, 2017 and February 2, 2024. However, on February 24, 2024, additional documentation was received which included a Rabies Vaccination Certificate dated January 9, 2021 from ******************************* 
  
  On February 24, 2024, Healthy Paws received a second claim submission for a vet visit dated February 22, 2024, for a refill of an anti-inflammatory medication with an invoice total of $139.43. Claim number 523832-1-2 was assigned. The claim was awaiting the medical records containing the required enrollment examination as previously noted. 
  

  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. The cruciate ligament is Healthy Paws only bilateral exclusion., which means if your pet has shown signs or symptoms of a cruciate ligament injury prior to enrollment or during the waiting period we are unable to cover cruciate ligament injuries in the future; therefore, it was pertinent to ensure full medical records for Tamzen were received to verify that she did not have an injury to the cruciate ligament on either knee prior to enrollment. 
  
  For pets less than six (6) years of age at the time of enrollment, the required enrollment exam, which you would have acknowledged at enrollment, 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. Tamzens required enrollment examination needed to be between October 24, 2016 and November 8, 2017.
  In order to fulfill the required enrollment examination, additional requests for medical records including doctors notes were sent to ****************************** and *************. Healthy Paws confirmed that neither East Bay SPCA or ****************************** had any additional medical records or notes to provide for Tamzen.
  

  On April 18, 2024, claim numbers 523832-1-1 and 523832-1-2 were adjudicated and denied.  The claim visit on February 2, 2024 was used to fulfill the pets required enrollment examination in accordance with the Claims Process Endorsement of the policy as outlined below. During the visit on February 2, 2024, ****** was evaluated for right rear lameness that progressed to the inability to bear weight after her walks.  It was suspected that she had a cruciate ligament injury. Since the clinical signs and symptoms were noted during the required enrollment examination, the injury was not eligible for coverage pursuant to the policy. The refill of the anti-inflammatory medication on February 22, 2024 was also not eligible for coverage as this was considered follow up care to the cruciate ligament injury.  
  

  Under Section II, the Claims Process Endorsement reads as follow:
  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, 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 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. 
  

  On April 22, 2024, Healthy Paws reviewed this matter pursuant to your April 20, 2024 inquiry. In review of the documentation received from *************, the medical records do indicate that an examination was performed during the visit on March 13, 2017. This examination was performed during the required enrollment examination timeframe. It was also confirmed that the clinic had purged any available doctors notes. In addition, the medical records for the claim visit on February 2, 2024 does not indicate any prior injury to the cruciate ligament in either leg. Therefore, it was determined that coverage could be extended for claim numbers 523832-1-1 and 523832-1-2.
  

  On April 23, 2024, claim number 523832-1-1 was reprocessed under claim number 523832-1-3. It was adjudicated and approved for reimbursement in the amount of $231.65, calculated as follows: the total covered amount of $602.06, minus your 20% coinsurance of $120.41, which equals $481.65, and applied towards your $250.00 annual deductible, for a total reimbursement of $231.65. 
  

  Claim number 523832-1-2 was reprocessed under claim number 523832-1-4. It was adjudicated and approved for reimbursement in the amount of $111.54, calculated as follows: the total covered amount of $139.43, minus your 20% coinsurance of $27.89, for a total reimbursement of $111.54.
  Healthy Paws has handled the processing of your claims 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

  04/13/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I have been a paying customer for 5+ years. I went through a hardship with a death in the family. My card had been stolen and I did not see the email notification about the payment. My policy was canceled and I was not offered any options. I have hardly used the insurance and paid in for so many years without any issues, this does not seem fair at all.

  

  Business response

  04/18/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company
  responding to your communication to the Better Business Bureau dated April 13, 2024regarding the cancellation of policy number I25085516 for your pet, Ares. Your policy was canceled due to non-payment of premium.
  As stated in Section III. 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 renew automatically 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. No coverage will be provided for any claim with a   date of veterinary treatment between the premium due date and the cancellation date, unless the premium payments are current.
  

  Your billing date is the 10th of each month. Recently, your account was suspended on March 10, 2024 as Healthy Paws was unable to collect your monthly premium. On March 10, 2024, an email notice was sent to you advising of the account suspension and providing advance notice that the policy was in danger of cancellation unless the premium due was received. A second notice including the Notice of Cancellation was provided on March 13, 2024 giving you further advance warning of the pending cancellation due to non-payment. This Notice of Cancellation was also mailed to your address on file via the United ********************* on March 13, 2024. On March 17, 2024, a third notice was sent notifying you of a scheduled cancellation date of April 7, 2024 at 12:01 AM Local Time.
  

  Healthy Paws reviewed this matter pursuant to the complaint. Our investigation shows you received four (4) notices that your account was in suspense status and was pending cancellation. In addition, our records show that the first emailed notice was opened the same day it was sent on March 10, 2024, providing you advance notice of a pending cancellation. The emails from March 13, 2024 and March 17, 2024 were opened on April 7, 2024. In addition, the investigation shows that the physical address and address reported to the BBB are different. Please confirm the accuracy of the physical address.

  We are sorry for the difficulties you have been experiencing including the loss of a family member. Taking these factors into consideration, we will reinstate your account per your request. Upon successful payment of the past due premiums for the policy period of April 11, 2024 thru May 10, 2024, in the amount of $109.44, your account with be reinstated without any lapse in coverage. Please be aware the next premium will also be due on May 10, 2024.
  

  A customer service liaison manager will follow up with you regarding the reinstatement process and your physical address.
  

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

   

  
  

• Initial Complaint

  04/12/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Healthy Paws has consistently raised my dogs insurance every single year since I signed of the service. In the last 9 years Ive used the service once I believe and they only paid 100ish dollars of a $300 dollar claim. Today I received a notification that they are raising their price again this year from 137 dollars a money to 203 this is a 66 dollar a month increase or 792 dollars a year. Im close to the point there my 10lbs dogs insurance(that has never been used more than 100 claim and probably paid at 10k at this point) is more expensive than my health insurance. The excuse when Ive called every year is that cost have gone up so they need to raise prices. This also happened last year or year before that they significantly raised the prices. Customers should not be spending as much or more on their pet insurance vs their own health insurance.

  

  Business response

  04/19/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of ACE Property & Casualty Insurance Company (ACE), is responding to your communication to the Better Business Bureau dated April 12, 2024 regarding a premium increase for Pet Health Insurance Policy number I10033329.

  On April 12, 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 $203.34 which will take effect on June 14, 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.
  

  On April 12, 2024, you called into our Customer Support Team and requested a cancellation of your policy. Your policy was cancelled on April 13, 2024 at 12:01 AM Local Time per your request.
  

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

  Customer response

  04/19/2024

   
  Complaint: 21568045
  
  I am rejecting this response because:
  
  Sincerely,
  
  *******************

• Initial Complaint

  04/01/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On February 23, 2024, my dog fell ill and ultimately needed to get her gallbladder removed. We submitted claim 329244-1-100 for her ******************* and have been awaiting reimbursement since. Healthy Paws called our animal hospital (Blue ***** in Brooklyn) requesting additional information shortly thereafter and shared with us that our claim should be paid out within 10 business days. The claim then needed additional information and we found that it was the SAME documentation that had already been sent by Blue *****. We then asked Blue ***** to send the medical records, and we also sent a copy ourselves. The claim continues to sit there without any update. We are told that it is in review every time we call and that Healthy Paws has everything it needs at the moment. It has now been more than 35 days since we submitted the claim.

  

  Business response

  04/09/2024

  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 April 1, 2024, regarding the adjudication of claim number 329244-1-100.  The claim was going through the approval process by the underwriter,  when the complaint was received.  
  

  On February 25, 2024, Healthy Paws received a claim submission for a visit on February 23, 2024, for treatment of a gallbladder mucocele and liver biopsies with an invoice total of $27,414.79. Claim number 329244-1-100 was assigned. A request for claim visit medical records with doctors notes from February 19, 2024 through February 23, 2024 was sent to your clinic on March 8, 2024. On March 9, 2024, medical records were received from ********************** dated February 23, 2024. This also included lab work spanning February 19, 2024 through February 23, 2024. However, daily doctors notes were missing from the medical records from February 19, 2024 through February 22, 2024, which are typically included with a hospital stay. The same day, another request was sent to the clinic for complete records of the visit. On March 25, 2024, another request was sent to the clinic for complete medical records with doctors notes for the claim visit. The same day, ********************** submitted duplicate medical records.
  

  As part of the claim investigation, we require full and complete medical records to determine claim validity and compensability. As doctors notes appeared to be missing from the original records received from ********************** on March 9, 2024, additional documentation was requested on March 25, 2024. BluePearl responded that same day. The hospital did not submit any additional daily doctors notes, the records appeared to be complete. Peppers prior history revealed no related pre-existing conditions, and a diagnosis was included in the records received. Therefore, Healthy Paws decided to proceed with the records on file.
  

  On March 28, 2024, the claim was reviewed by the adjuster and submitted for approval by the underwriter on April 1, 2024. On April 3, 2024, the claim was approved for processing.  Claim number 3229244-1-100 was adjudicated and approved for reimbursement in the amount of $23,828.21, calculated as follows: the total covered amount of $26,475.79, minus your 10% coinsurance of $2,647.58, for a total reimbursement of $23,828.21. The Examination and Consultation fees for a total amount of $939.00 was not eligible for coverage pursuant to your policy.
  

  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.
  

  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

  04/09/2024

   
  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,
  
  Titipong Watanasookchai

• Initial Complaint

  03/22/2024

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  Company is refusing to process a claim for a dog they have insured since was 8 weeks old. They are asking for his previous medical records. The dog has never been sick and gets yearly shots. He is a healthy 4 year old dog. The first claim we filed was after paying for 4 years. We provided all his shot records from the vet since he was with us at 8 weeks. We provided all the information from the vet for the claim. We only get auto emails from them. The phone number takes to a call center where no one knows anything. It is basically the run around. There is countless law suits against this company and several class action law suits. It is impossible to hold anyone accountable because you never speak to a healthy paws employee just a different rep at a call center or a different bot on email. There is no way to escalate to a manager. This company is scamming loving dog owners who could be saving money for Their pets in an account for when they get sick. Cheating pet owners is despicable. It is also illegal. This company is stealing. It is impossible to provide them with what they are asking. There is no such thing as medical records for healthy dogs. There are shot records. A wellness exam wasn't required when you sign up. A healthy dog would not have a yearly medical records if they didn't get sick. You don't just randomly take your dog to the vet. The purpose of this company is insurance. The dog has had insurance since we obtained him at 8 weeks old. The dog has all his shots. If there was a previous medical record it would have been a claim. Our records are of shots and teeth cleaning. They are asking us for something that doesn't exist on purpose. Why wouldn't they get the previous records upfront? If you don't have them or what they require to pay a claim/ provide insurance than you should not be able to buy pet insurance. So you pay them for nothing. Utterly disgusting. Disappointed and taken advantage of along with so many others. I want a refund.

  

  Business response

  03/28/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company (Westchester), is responding to your communication to the Better Business Bureau dated March 22, 2024, regarding the adjudication of claim numbers 821453-2-1 through claim number 821453-2-5, for your pet Teddy ************************ January 30, 2024, Healthy Paws received a claim submission with multiple invoices. An invoice dated January 4, 2024, was received for the medication Prazosin, which is prescribed for urinary issues, and a total invoice amount of $21.34. Claim number 821453-2-1 was assigned. An invoice dated December 26, 2023, for a miscellaneous charge and antibiotics, with a total invoice amount of $199.35, was assigned claim number 821453-2-2. An invoice dated December 23, 2023, for behavioral medications, bloodwork, and wellness care, with a total invoice amount of $403.79, was assigned claim number 821453-2-3. An invoice dated January 3, 2024, for treatment of a urinary condition, including an unknown Vetology AI Fee, for a total invoice amount of $609.00, was assigned claim number 821453-2-4. An invoice dated January 5, 2024, for behavioral medications, antibiotics, and preventative medication, with a total invoice amount of $165.51, was assigned claim number 821453-2-5.
  
  A request for complete medical records with doctors notes was sent to you between January 31, 2024 and March 1, 2024. On February 5, 2024, medical records were received from **************** dated January 3, 2024. On February 20, 2024, additional medical records were received from **************** dated December 23, 2023. On March 3, 2024, you reached out to ******************* and requested your pets medical records. On March 12, 2024, you submitted medical records from ******************* spanning November 15, 2019 to June 3, 2022. These were sent in a reply email directly to a **************** Representative that had yet to review it. However, on March 21, 2024, the records were reviewed, and claim number 821453-2-1 was opened for processing. Subsequent claims were placed in a pending status awaiting the adjudication of this claim.  
  
  The processing of claims is based on the medical records and documentation that is submitted by you, and/or your veterinarian, including the required enrollment examination. 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. To complete the enrollment process, you would have had to further acknowledge that an enrollment examination was performed within the past twelve (12) months, or one would be fulfilled within the next fifteen (15) days. Medical records, which included the required enrollment examination, were submitted by you on March 12, 2024.
  
  III. GENERAL CONDITIONS
  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 March 22, 2024, claim number 821453-2-1 was adjudicated and approved for reimbursement in the amount of $17.07, which was applied towards the pets annual deductible, calculated as follows: the total covered amount of $21.34, minus the pets 20% coinsurance of $4.27, which equals $17.07, and applied towards the pets $250.00 annual deductible. This leaves a remaining annual deductible of $232.93.
  
  On March 22, 2024, claim number 821453-2-3 was adjudicated and approved for reimbursement in the amount of $221.27, which was applied towards the pets annual deductible, calculated as follows: the total covered amount of $276.59, minus the pets 20% coinsurance of $55.32, which equals $221.27, and applied towards the pets $232.93 annual deductible. This leaves a remaining annual deductible of $11.66. The Office Visit, behavioral medication and vaccine were not eligible for coverage pursuant to your policy.
  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.
  The vaccination was not eligible for coverage pursuant to your policy.
  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.
  The medication Acepromazine was not eligible for coverage as behavioral medications are excluded on the policy.
  Section II. EXCLUSIONS & LIMITATIONS
  4) OTHER EXCLUSIONS
  We do not reimburse the costs, fees or expenses associated with:
  s. Training, therapy, medications or other methods or forms of behavioral modification.
  

  On March 22, 2024, claim number 821453-2-5 was adjudicated and approved for reimbursement in the amount of $46.82, calculated as follows: the total covered amount of $73.10, minus the pets 20% coinsurance of $14.62, which equals $58.48, and applied towards the pets remaining annual deductible of $11.66, for a total reimbursement payment of $46.82. The behavioral medication and flea preventative were not eligible for coverage pursuant to your policy, as noted above.
  

  On March 23, 2024, Healthy Paws reviewed this matter pursuant to your March 22, 2024 inquiry. As a preliminary matter, claim numbers 821453-2-1, 821453-2-3, and 821453-2-5 were processed prior to the receipt of this complaint.
  

  On March 27, 2024, after the receipt of claim visit medical records received on March 26, 2024, claim number 821453-2-2 was adjudicated and approved for reimbursement in the amount of $199.35, calculated as follows: the total covered amount of $249.19, minus the 20% coinsurance of $49.84, for a total reimbursement of $199.35. The Kong and Donation were not eligible for coverage as these were not medically necessary. 
  
  I. INSURING AGREEMENT
  1) WE COVER: Reimbursement of the cost incurred by you for medically necessary veterinary treatment recommended by your veterinarian for conditions covered by this policy. These costs will be covered when your pet:
  a. develops an illness, or
  b. has an injury as a result of an accident;
  
  On March 27, 2024, additional information was received regarding the Vetology AI Fee, and it was determined this charge was eligible for coverage. Claim number 821453-2-4 was adjudicated and approved for reimbursement in the amount of $355.67, calculated as follows: the total covered amount of $444.59, minus the 20% coinsurance of $88.92, for a total reimbursement of $355.67. The Donations and Exam fee were not eligible for coverage as these were not medically necessary, as noted above. The urinary ********* were also excluded from coverage pursuant to your policy.
  Section II. EXCLUSIONS & LIMITATIONS
  4) OTHER EXCLUSIONS
  We do not reimburse the costs, fees or expenses associated with:
  j. Special diets, foods, vitamins, grooming, nail trims, shampoo and bathing;
  
  We are unable to accommodate your request for a full refund of premiums. Premiums collected by Healthy Paws on behalf of Westchester protect the pet against accidents and illnesses covered under the policy. This policy has been in effect since November 21, 2019, and coverage has been provided since the inception of the policy. This includes the processing of fourteen (14) claims and a total of $2,451.48 in covered claims.  Therefore, premiums cannot be refunded back to inception. If you are interested in cancelling your policy for one or both of your pets, you are welcome to send a request to ****************************** and a Customer Liaison Manager will assist you.
  
  Healthy Paws has handled the processing of your claims 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

  04/01/2024

   
  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

  03/21/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I submitted a claim to Healthy Paws Pet Insurance for a visit on March 4th which resulted in a euthanasia and cremation. Healthy Paws is claiming the line items on the invoice doesn't add up to the total shown on the bottom. I spoke with the *************** and went through each line item one by one which totaled correctly. I went through the same exercise with Healthy Paws and came up with the correct total. The woman on the phone said there's nothing she can do it's the auditors but won't connect me with them. I've used my credit card which is a 20% fee so the longer this goes the more money it costs me.

  

  Business response

  03/27/2024

  Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Westchester Fire Insurance Company (Westchester), is responding to your communication to the Better Business Bureau dated March 21, 2024, regarding the adjudication of claim number 196374-2-44.  The claim was approved for reimbursement on March 22, 2024.
  

  On March 19, 2024, Healthy Paws received a claim submission for a visit on March 4, 2024, for emergency hospitalization, treatment, and euthanasia in the amount of $3,031.32. Claim number 196374-2-44 was assigned. On initial review, the total claim line items discounts added up to $110.63, while, the Included Discounts noted at the bottom of the invoice indicated only $61.48 was applied. 
  

  On March 21, 2024, you reached out to Healthy Paws to clarify how the -$50 discount was applied. Your clinic had not included this amount in the Included Discounts noted at the bottom of the invoice and it was to be applied towards the Radiograph-Thorax 3 View w/Interpretation. The ************* Team member you spoke with over the phone made a note in the claim for the claims adjuster to review. 
  

  On March 22, 2024, claim number 196374-2-44 was adjudicated and approved for reimbursement in the amount of $2,019.06, calculated as follows: the total covered amount of $2,836.32, minus your 20% coinsurance of $567.26, which equals $2,269.06, and applied towards your $250.00 annual deductible, for a total reimbursement of $2,019.06. The Exam-Emergency for $195 was not eligible for coverage pursuant to your policy.
  

  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.
  

  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.
  

  
  

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