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Complaint Details
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Initial Complaint
04/20/2024
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Answered
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
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
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
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 WatanasookchaiInitial Complaint
03/22/2024
- Complaint Type:
- Order Issues
- Status:
- Resolved
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
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.
Initial Complaint
02/22/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I have been a paying subscriber for Healthy Paws Insurance for my dog since 2016 - Policy # ******** (Pet ID *********. On 12/17/2023 an email was sent to me that after 6+ years of autopay my credit card payment did not go thru for an approx ***** charge to Healthy Paws for premium payment. I checked my credit card account and did not see any change in my credit card number so did not see the need to update payment. Subsequently on 1/12/2024 an email was sent stating my policy was cancelled due to non payment. I never saw this email (it was not opened until 2/21/2024 when I realized I could not login to my Healthy Paws account). When I contacted customer service I asked why I was not sent a certified letter regarding cancellation of a policy with less than 90 days notice. The terms on Healthy Paws website say that cancellation may occur with 90 days written notice from Healthy Paws. As a loyal customer to ******************** Paws who had never missed a payment there was not even a shred of compassion from the phone representatives. The email about an issue with my credit card came when I was sick with COVID, home with two premature infants with COVID and as a mother and young widow it did not even cross my mind that I needed to update the card within 20 days - as I expected to get some sort of more urgent message (now looking back on the email in small print without capital letters or anything to stand out Healthy Paws casually write they can cancel the policy). It seems that this company is happy to have taken premiums from an honest and well intentioned pet owner only to cancel the policy over a clear credit card error from my bank. Meanwhile no other companies have sent me any notice that my autopay is not working. Healthy Paws told me after my initial call to sign up for a new policy but as it turns out my dog is no longer insurable because she is over 5 years old. The ethical thing to do would to reinstate the policy - I even offered to pay the annual premium in full.Business response
03/01/2024
Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Indemnity Insurance ******* of North America (Indemnity), is responding to your communication to the Better Business Bureau dated February 22, 2024 regarding the cancellation of policy number I11599163 for your pet, ********. 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 14th of each month. Recently, your account was suspended on December 14, 2023 as Healthy Paws was unable to collect your monthly premium. On December 14, 2023, 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 was provided on December 17, 2023 giving you further advance warning of the cancellation of the policy due to non-payment. This Notice of Cancellation was also mailed to your address on file via The ************* ************** on December 18, 2023. On December 21, 2023, a third notice was sent notifying you of a scheduled cancellation date of January 12, 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 on December 16, 2023, providing you advance notice of a pending cancellation.
We are very sorry for the difficulties you have been experiencing and as per our phone call with you on February 29, 2024, Healthy Paws reviewed your request and, pending receipt of outstanding premiums due, we will reinstate your account. Upon successful payment of the past due premiums for the policy period of December 15, 2023 thru January 14, 2024, January 15, 2024 thru February 14, 2024, and February 15, 2024 thru March 14, 2024, in the amount of $208.41, your account with be reinstated without any lapse in coverage.
A customer service liaison manager will follow up with you regarding the reinstatement process and your upcoming annual policy renewal.
Should you have any questions or concerns, please do not hesitate to contact us. Thank you.
Customer response
03/01/2024
Complaint: 21334602
I am rejecting this response because:
I was contacted by customer Liaison "********** 2/27/2024. She left no call back number. I replied to her email to set up a time to talk - no response. She called me 2/29/2024 and said I would get an email to make payments and set up account. It's been 24 hours and no email and no contact information for follow up.
Sincerely,
***********************Business response
03/19/2024
Healthy Paws Pet Insurance, LLC (Healthy Paws) is responding to your follow-up communication to the Better Business Bureau, dated March 13, 2024, regarding the reinstatement of your pet health insurance policy for ********. Your account is currently active and in good standing.
On February 27, 2024, a Customer Liaison Manager (***) reached out to you via phone. As you were not available at the time of the call, a voice mail was left for you. An email was also sent the same day requesting your available dates and times to connect. You responded to the email providing February 29, 2024 at 10:00 am as the preferred date and time. After speaking with the *** regarding the status of your cancelled account, a summary of the conversation was sent to you. This email requested confirmation on your end to reinstate your account. On March 6, 2024, you emailed the *** asking for a status update on the reinstatement of your cancelled account. A copy of the original email was forwarded to you for review. On March 7, 2024, you confirmed reinstatement of your account. Later that day, an email was sent to you with a link to update your billing information. This action would assist in bringing your account to an active status. Later that day, you updated the billing information. Your account was returned to active status on March 8, 2024 after payment was received.
Thank you.
Initial Complaint
02/14/2024
- Complaint Type:
- Delivery Issues
- Status:
- Answered
Monthly coverage for my pet was raised from ***** to ****** in one month. I never received a notice from company.It's too much!Business response
02/21/2024
Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Indemnity Insurance ******* of North America (Indemnity), is responding to your communication to the Better Business Bureau dated February 14, 2024 regarding a premium increase for Pet Health Insurance Policy number I1151103A.
On December 11, 2023, 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 $132.00 which took effect on February 12, 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.
Our records show the above referenced Policy Anniversary Communication Notice we sent you by email on December 11, 2023 was opened on January 4, 2024. We are unable to make any changes to the premium rating that would deviate from those filed with the state.
Please let us know if you have any further questions or concerns.
Thank you.
Initial Complaint
02/12/2024
- Complaint Type:
- Billing Issues
- Status:
- Resolved
I have been using Healthy Paws Pet Insurance since 2020 for my dog. Recently, I discovered that I was being charged an increased premium for living in the ****************, despite living in the *********************** as of 12/26/2022. I contacted Healthy Paws Pet Insurance upon moving to let them know my new address. Today I spoke with a Healthy Paws Pet Insurance representative who told me that my actual premium was $24 for the ***********************, and not $64. I explained to the representative that my address was updated prior and that I've been paying additional premium for the wrong state. She told me that I could not be refunded for being charged the incorrect premium prior, which I'm not sure how this is ethical or legal as this is hundreds of dollars of incorrectly charged money. They have correctly updated my address and told me moving forward I would be charged the correct premium of $24 for my correct ***********************, but I would like a retroactive refund for the difference in premium I made since moving. The account is under: *********************** ************ ********************* for my pet *****************.Business response
02/20/2024
Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of current underwriter ACE Property & Casualty Insurance Company (ACE), is responding to your communication to the Better Business Bureau dated February 12, 2024, regarding your change of address and request for a refund.
Healthy Paws reviewed your inquiry on February 13, 2024. Records show that you registered the account under the mailing, billing, and physical address in *****,******* on September 20, 2020. On May 7, 2023, you made a change to the mailing address from the **************** to ************** in the *************** Portal, but you did not update your physical address or billing address. As premiums are based on you and your pets physical address, the premium was still being calculated based on your ******* address.
You also mentioned in the BBB inquiry that you contacted Healthy Paws regarding your move. However, we do not show any record of a call or written request from you to change the physical address from ******* to ************** prior to February 12, 2024.
On February 16, 2024, a Customer Liaison Manager reached out to you and has resolved your inquiry.
Please note that your deductible has changed from $200 to $250 per the rates and filing rules approved under Westchester Fire Insurance Company in the ***********************.
Thank you.
Customer response
02/21/2024
Complaint: 21282462
I am rejecting this response because: the business has not proposed a solution for their error. My monthly premium was updated to the correct premium of my current state of residence; however, I would like a retroactive refund for being charged the incorrect premium previously. The business states that I did not update my address appropriately which is false. My address was updated online and I also did call the company to inform them of my move. I am hoping for a retroactive refund of the difference I paid. Thank you.
Sincerely,
***********************Business response
02/29/2024
Thank you for your follow-up inquiry regarding your refund. A refund was issued back to the payment method on file on February 15, 2024 in the amount of $290.69. Please verify with your bank that the refund was applied to your account.
Thank you.
Customer response
02/29/2024
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
02/10/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I enrolled my rescue dog Mo in Healthy Paws pet insurance on 9-4-17, shortly after I adopted him. Mo's policy #I10952384, see screenshot, states he has been "protected since 9-19-17." I paid his monthly premium on time for the past 6 years and 4 months, total $5,794.24. I submitted a claim on 12-29-23 and received a response from Healthy Paws on 2-6-24 stating they needed Mo's medical records from 9-4-16 to 9-19-17, a period of time before I adopted Mo, in order to process the claim. Mo was found on the street so there are no records from this time period. ** confirms they have all his records from 6-2-18 to present. My complaint is that ** was apparently never covered by **'s insurance plan, and is not covered now, because he is ineligible due to the fact that he's a rescue dog and prior medical records don't exist. I can't understand why this information wasn't shared with me for over 6 years. I am filing a complaint because ** made the same claim just 3 weeks earlier for my other rescue dog **** #I10952384 who has been enrolled in the ** plan since 8-13-16 and who, according to her account, has been "protected since 8-28-16" (see screenshot.) I have paid ****'s premium every month, on time, for 7 years and 6 months totaling $4,329.90. I filed a claim for **** on 12-29-23 and received the same response I got for Mo, that she was missing medical records from the 12 months before her enrollment date on 8-13-16. What's most confusing is that she was born on 3-7-16 so the records they are requesting also don't exist. If I'm understanding ** communications correctly, neither of my dogs have ever been covered by their policies despite the fact that I have paid over $10,000 in premiums over more than 7 years. Never during that time did ** indicate my pets weren't covered. Now that I submitted claims, I'm told my pets are missing documents that don't exist. I don't want reimbursement - I simply want ** to honor the terms of my policy without further antics.Business response
02/21/2024
Healthy Paws Pet Insurance, LLC (Healthy Paws), the managing general underwriter on behalf of Indemnity Insurance ******* of North America (Indemnity), is responding to your communication to the Better Business Bureau dated February 10, 2024, regarding the delay in processing of your pets claims due to missing documentation, including the required enrollment examination.
For pets less than six (6) years of age at the time of enrollment, the required enrollment exam, which you acknowledged at the time of 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. Accordingly, ***** required examination needed to be between August 14, 2015 and August 28, 2016.
For pets six (6) years of age or older at the time of enrollment, the required enrollment exam must have taken place either in the thirty (30) days prior to the pet policy effective date, or within fifteen (15) days following the pet policy effective date. Accordingly, Mos required examination needed to be between August 5, 2017 and September 19, 2017.
On December 29, 2023, Healthy Paws received a claim submission for **** for a visit on November 15, 2023, for a dental cleaning with extractions and a total invoice amount of $1,249.90. Claim number 400005-1-3 was assigned. Requests for your pets complete medical records with doctors notes were sent to you between January 2, 2024 and January 17, 2024. On January 2, 2024, medical records were received from ************************* spanning May 30, 2018 to December 12, 2023. However, medical records prior to May 30, 2018, including the required enrollment examination that you acknowledged at the time of enrollment, were still needed to adjudicate your claim. On January 22, 2024, medical records were received from One ******************** spanning May 29, 2016 to May 27, 2017. With complete medical records now on file, the claim was opened for processing.
On January 24, 2024, claim number 400005-1-3 was adjudicated and denied as the treatments provided fell under the dental health care exclusion of your policy.
Section II. EXCLUSIONS & LIMITATIONS
3) PREVENTIVE EXCLUSIONS
We do not cover:
d. Dental health care, however if injury to teeth is caused by an accident, we do cover the cost of extraction and/or reconstruction of damaged teeth.
V. DEFINITIONS:
10) ******************* The regular care required to maintain dental hygiene for your pet. This includes brushing, scaling, polishing, extractions, and reconstructions.On December 29, 2023, Healthy Paws received two (2) claim submissions for Mo. The first was for a visit on November 18, 2023, for an antibiotic with a total invoice amount of $42.57. Claim number 400005-5-5 was assigned. The second was for a visit on November 14, 2023, for a urinalysis with a total invoice amount of $186.30. Claim number 400005-5-6 was assigned. Requests for your pets complete medical records with doctors notes were sent to you between January 6, 2024 and February 11, 2024. On January 20, 2024, medical records were received from ***************************** spanning June 2, 2018 to November 6, 2023. The medical records note that Mo was evaluated at a previous veterinary clinic for a chronic condition. To adjudicate the claims, medical records were still needed prior to June 2, 2018, including the required enrollment examination. Medical records were also needed from *************************, where ** was evaluated in November 2023.
On February 4, 2024, Healthy Paws received another claim submission for a visit on January 30, 2024, for lethargy and hindlimb lameness, with an invoice total of $382.88. Claim number 400005-5-7 was assigned. The claim was waiting for additional documentation to be adjudicated, as noted above.
Healthy Paws reviewed this matter pursuant to your February 10, 2024 inquiry. As a preliminary matter, complete medical records were received for ****, and her claim 400005-1-3 was processed before the receipt of this complaint. In review of Mos policy, claim number 400005-5-2, received on January 23, 2023 and claim number 400005-5-3, received on March 19, 2023, were both closed due to missing documentation and the length of time the claims were open. Complete medical records had previously been requested for Mo to adjudicate these claims. However, no documentation was received.Requests for medical records were sent to ************************* and One ******************** on February 12, 2024. Medical records were received the same day from One ******************** spanning November 16, 2017 to June 25, 2018. On February 13, 2024, medical records were received from ************************* spanning August 11, 2018 to February 10, 2024. Medical records on November 16, 2017 from One ******************** indicate Mo was adopted three (3) months prior and this was the first visit with them.
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 on Mo within the past thirty (30) days, or one would be fulfilled within the next fifteen (15) days. If you had selected yes, you would have been able to continue the application process. However, if you had selected no, a pop-up box would have appeared with the requirement that an examination would need to be performed in the next fifteen (15) days. As no action was taken in accordance with the policy requirements, the next available examination was used per the policy endorsement below, and the visit on November 16, 2017 was used to fulfill the required enrollment examination. The claims were subsequently opened for processing. An email was sent to you detailing how this affects Mos future coverage on February 13, 2024.
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.Claim number 400005-5-5, for the visit on November 18, 2023, with a total invoice amount of $42.57, was approved for reimbursement in the amount of $34.06, which was applied towards the annual deductible, calculated as follows: the total covered amount of $42.57, minus your pets 20% coinsurance of $8.51, which equals $34.06, which was applied towards the $500.00 annual deductible. This leaves a remaining annual deductible of $465.94.
Claim number 400005-5-6, for the visit on November 14, 2023, with a total invoice amount of $186.30, was approved for reimbursement in the amount of $81.36, which was applied towards the annual deductible, calculated as follows: the total covered amount of $101.70, minus your pets 20% coinsurance of $20.34, which equals $81.36, which was applied towards the $465.94 annual deductible. This leaves a remaining annual deductible of $384.58. The Office Visit for $94.00 (with the applied discount) was not eligible for coverage pursuant to your policy.
Section II. EXCLUSIONS & LIMITATIONS
1) GENERAL EXCLUSIONS
We do not cover:
a. Veterinary examination fees.Claim number 400005-5-7, for the visit on January 30, 2024, with a total invoice amount of $382.88, was approved for reimbursement in the amount of $232.58, which was applied towards the annual deductible, calculated as follows: the total covered amount of $290.73, minus your pets 20% coinsurance of $58.15, which equals $232.58, which was applied towards the $384.58 annual deductible. This leaves a remaining annual deductible of $152.00. The Office Visit for $97.00 (with the applied discount) was not eligible for coverage pursuant to your policy, as noted above.
Claim number 400005-5-2 was reopened for processing, for the visit on January 10, 2023, for a dental with extractions and a total invoice amount of $1,382.68, The claim was denied pursuant to your policys dental health care exclusion.Section II. EXCLUSIONS & LIMITATIONS
3) PREVENTIVE EXCLUSIONS
We do not cover:
d. Dental health care, however if injury to teeth is caused by an accident, we do cover the cost of extraction and/or reconstruction of damaged teeth.
V. DEFINITIONS
10) ******************* The regular care required to maintain dental hygiene for your pet. This includes brushing, scaling, polishing, extractions, and reconstructions.Claim number 400005-5-3 was reopened for processing, for the visit on January 4, 2023, for pre-operative bloodwork for Mos dental and a total invoice amount of $306.27. The claim was denied pursuant to your policys dental health care exclusion, as noted above.
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
02/25/2024
Complaint: 21276337
I am rejecting this response because: Thank you Healthy Paws for the very detailed response from your attorneys. If I understand correctly, you are alleging that my pets were never eligible for coverage,despite the fact that you enrolled them in your plan, because their medical records did not meet your requirements. I rescue abandoned and abused dogs and cats. Until recently, I had 5 dogs and 2 cats, all insured through Healthy Paws. You invoiced me monthly for all of them and even assigned ID and policy numbers to each.There was never any indication in my account that any of my pets were missing documentation and would not be eligible for future claims - and there still isnt (see attached screen shot taken today of Mos policy.)
I would like to add that I am meticulous with the health and well-being of my pets all are up-to-date on vaccines, never miss their annual physicals, visit the vet when they are sick, eat healthy food and even receive regular dental care. Part of being a responsible pet owner is having health insurance, which is why I have continued to enroll each new rescue dog I adopt.
My vet has provided all requested medical records in a timely fashion, and I never received notification from HP informing me that any documents were missing nor that any of my pets would not be eligible for a claim in the future. If this information is not noted in my account (see screenshot,) nor was ever communicated with me, and HP continued to invoice me monthly for these policies over the course of many years, totaling tens of thousands of dollars in premiums, which I paid, I dont understand how this could be remotely legal and it is clearly, at the very least, an egregious display of callous corporate greed.
This is not a victimless crime - my pets, or those of other HP customers, could die because they needed medical care we could not afford which is the protection we expected when we enrolled them in a health care plan. Mos HP policy says he has been protected since 9/19/17 (see screenshot) when in fact, he was never protected and I kept paying my monthly premiums in good faith, never imagining I was being scammed.
Sincerely,
*************************
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Customer Complaints Summary
225 total complaints in the last 3 years.
62 complaints closed in the last 12 months.