Healthy Paws Pet Insurance LLC

Complaint: ***
I am rejecting this response because:an eye infection is not a pre-existing illness and there is not evidence that the two separate incidences are linkedThis was a bacterial eye infection that occurred after a separate exposure to something environmentalIt is not an illness or a condition
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because:This policy was a scam. They did refund a portion of my payments but I want the whole amount backThis was totality worthless to haveI paid for this policy it covers nothing. Basically they are saying anything prior to the policy and found on the initial visit won't be coveredThey will find everything to be a pre-existing conditionI paid for this and my dog to have a mass removed. I could have paid for the surgery for what I wasted paying them. This policy was rather pricy too, a month, that's half of what I post for my own insuranceMine actually covers things=worth havingI just want my money back to pay off this debtI charged it to a credit card paying high interest. I also spoke to customer service reps that lead me to believe this would be covered. It took almost months to get an answer, it's like they keep you hanging on to get that premiumAgain this is a total scam, I could have shredded my money and got the same result.
Sincerely,
*** ***

Revdex.com:
I have no choice but to accept because I don’t want to keep going in circles. It’s a sketchy business practice taking advantage of current customers making them pay higher premiums than other new enrolled customers and trap them into a higher premium simply because they know that if your pet has a condition they know it is hard for you to leave insurance because most insurance do not accept pre-existing condition. Thabkfully my pet does not have any pre-existing condition so I have chosen to cancel my policy effective the end of my billing cycle May 12th (give and take a few days) but it is a shame you take advantage of customers and make them pay more money. i hope this is made public  
Sincerely,
[redacted]

Healthy Paws’ claims determinations are based off of the information provided in the medical records by the pet’s veterinarian including when the signs and or symptoms presented. As outlined in the Policy, we are unable to provide coverage for any clinical signs or symptoms that occurred or...

displayed any signs and/or symptoms prior to the Policy effective date. If signs or symptoms occurred or displayed prior to the policy effective date they are considered pre-existing and we are unable to provide coverage.Ms. [redacted]'s pet was treated for cancer in 2013, which was prior to enrollment, Healthy Paws has excluded coverage for treatment related to cancer, as outlined in the policy. Specifically, this pet had a type of cancer, rhabdomyosarcoma, prior to the policy effective date and is currently being treated for anaplastic sarcoma; both cancers are in the sarcoma classification. Honoring the Pet Parent’s request and disagreement regarding these claims, Healthy Paws has sent all relevant information to an independent third-party veterinarian to make a final coverage determination. This veterinarian review is currently in progress, and results have not yet been returned to Healthy Paws or the Pet Parent.Healthy Paws provided coverage for treatments where cancer was not yet a definitive diagnosis. These claims, where a definitive diagnosis could not be obtained, were reimbursed in the amount of $14,061.84.We understand how stressful it can be when your furry kids are not feeling well and we wish the best for her sweet girl and hope she's feeling her best in response to the treatments.

We’re sorry to lose you as a customer. All cancellations must be in writing or by clicking a “cancel” link we send to you via email. You can find the cancellation language in our policy:Page 4 of 7III. GENERAL CONDITIONS2) You may cancel your policy by notifying us in writing via regular mail, fax...

or email at least fourteen (14) days in advance of your next premium payment.Page 5 of 7IV. ADDITIONAL CONDITIONS2) CANCELLATIONb. You may cancel this policy at any time by notifying us in writing via regular mail, fax or email. This is in accordance with the provisions of III. GENERAL CONDITIONS 2).Based on our records, we did not have any written communications that you wanted to cancel your policy which is why your account remained active. Here is a history of our communications:12/19/2017 at 4:19 pm Healthy Paws refunded policyholder effective 5/20/2017 in the amount of $784.78. Sent a email confirmation of the refund transaction to the policyholder.12/18/2017 at 4:34 pm Received a signed claim form from policyholder via fax.12/18/2017 at 9:05 am Phone call from policyholder requesting to cancel policy. Policyholder stated that she sent a fax request in May but we do not have this written request on file. 12/17/2017 at 2:57 pm Phone call from policyholder updating credit card and asking how to file a claim.5/20/2017 at 1:48 pmPhone call from policyholder stating that she canceled her policy in February. We let her know that we do not have a written request on file to cancel her account. Please confirm cancellation by clicking the cancellation request link in the email we sent a few moments earlier.5/20/2017 at 1:36 pmPhone call from policyholder inquiring about how long she had the policy and date of last claim filed which was 10/20/2016. She believed she canceled our policy. We shared that we do not have any written record of her canceling and sent an email with a link to cancel her policy. The link was not used as our system would have automatically canceled her account and stopped the billing process.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

Healthy Paws offers continuous lifetime coverage for your pet. Our policy is continuous until canceled and you can increase your coverage as long as you have not submitted a claim. Once you have submitted a claim, you will be able to decrease coverage, but will no longer have the option to increase...

the plan. Since you filed claims for your pet, you no longer had the option to increase coverage, which was why we did not approve your request to lower your deductible. You can find this information in our Policy, on page 4 of 7:III. GENERAL CONDITIONS 7)  You are entitled to increase your pet’s deductible level and/or increase your pet’s coinsurance amount at any time. This request must be made in writing and will become effective the month following approval by us. You may apply to lower your pet’s deductible level and/or decrease your pet’s coinsurance amount provided that your pet has not previously filed a claim with us. This request must be in writing and will become effective the month following approval by us. You can also find information about changing your deductible on our FAQ:https://www.healthypawspetinsurance.com/frequent-questionsManaging Your Policy4. Can I change my deductible or reimbursement level after enrolling?You can increase your coverage as long as you have not submitted a claim. Once you have submitted a claim, you will be able to decrease coverage, but will no longer have the option to increase your plan.You can view your reimbursement and deductible options by clicking Pet Policies in your customer center to change your policy options.Increasing your coverage would include raising your reimbursement and/or lowering your annual deductible, resulting in less out of pocket expenses before receiving reimbursement, and a higher monthly premium.Lowering your coverage would include decreasing your reimbursement and/or raising your annual deductible, resulting in more out of pocket expenses before receiving reimbursement, and a lower monthly premium.In regard to the annual premium adjustment, we understand that premium increases can be a stress financially. Our goal is to keep our premiums as low as possible while still providing comprehensive coverage. Your monthly bill is going up because veterinarian care has grown more expensive over the last few years. This premium adjustment allows continued access to the best veterinarian care. It is important to us to keep premium adjustments manageable and we notify you 60 days prior to the premium adjustment to allow time to plan and budget. Premiums for potential customers will increase over time as well. At the time your premium increase takes effect, you will likely see an overall increase in premiums for other customers as well. If you were to create a new policy after your policy anniversary date, the premiums will be higher than the current premium for your pet.We strive for complete transparency so our pet parents understand how the policy works. We outline coverage changes and annual increases in our frequently asked questions and in our sample policy available prior to enrollment. Our team members are always happy to answer any policy questions as well.https://www.healthypawspetinsurance.com/frequent-questions

Healthy Paws’ complete accident and illness plan covers injury to the teeth if it is caused by an accident, including extractions and reconstruction of damaged teeth. Like most pet insurance companies, our plan does not cover the regular dental care required to maintain dental hygiene for the pet,...

including brushing, scaling, polishing, extractions and reconstructions.Medical records received with your claim indicated an extraction due to bone loss, rather than an accident to the mouth. Typically, bone loss is caused by periodontal disease. We understand that there may be situations where a veterinarian shared the cause of a condition in a conversation and not in the medical records. If the extraction was due to an accident, we are always happy to review updated notes or clarification from your veterinarian.Please don’t hesitate to reach out to us at any time if you have questions or would like any additional information. We hope your furry kiddo is feeling well after the recent dental surgery!

To determine coverage for new accidents, illnesses, and injuries, we request your pet’s full medical history including the enrollment exam notes at the time of your first claim. This includes medical records since your pet joined your family through the date of the first claim. It was noted upon...

your online application that your pet had seen a veterinarian within the 12 months prior to enrollment, satisfying the enrollment exam requirements in our policy. However, we had not yet received medical records for your pet within this time frame. Though we do not currently have complete medical history, we were able to provide coverage for your pet’s cruciate ligament surgery based on medical records currently on file. A detailed outline of our communications and claim process for your pet is included below. We hope your furry kiddo is doing well and healing quickly after his surgery!On 1/30/2018 we sent an email to let you know we received medical records for the date of your pet’s claim, but were missing previous medical history in order to process the claim. On 1/31/2018 we spoke on the phone to discuss details of missing medical records needed to process your claim. To help gather medical records, we requested history from the two clinics your pet had recently seen, but only received records for the date of your first claim to present. On 2/8/2018 the claim was closed due to the length of time it had been opened, and we sent an email to let you know we were still missing previous medical history. On 2/9/2018, we received an invoice for a visit prior to enrollment as a claim submission. This claim submission was closed and kept on file, as we are unable to process claims prior to your policy effective date. This was the claim you noted had disappeared, since this claim was not eligible for processing. On 2/15/2018 we spoke with you on the phone to discuss the missing medical records needed to process your claim. On 2/16/2018 we received partial medical history and were still missing the information from your pet’s enrollment exam noted on your online application to complete full medical history. On 2/21/2018 we returned a voicemail we received asking about the status of medical records and your pet’s claim. We were unable to reach you, but left a voicemail in return with our contact information to reach us to discuss your pet’s claims and medical history. On 2/27/2018, we received an email asking about the status of your pet’s claim, and a claims processor took a detailed look into your account to see if we could provide any additional assistance for you, though medical history was still incomplete. On 3/6/2018 we reviewed the limited medical history on file again to see if there was enough history to appeal your pet’s claim and we’re happy to say that we were able to provide coverage for his surgery. We sent an email the same day to let you know you would be receiving your reimbursement shortly. Thank you for your patience. We wish you and your pet the very best, and hope he is back on his paws and excited to run around again once he’s fully recovered!

Healthy Paws requests your pet’s full medical history at the time of the first claim. This includes medical records since your pet joined your family and through the date of the first claim. By obtaining full medical history through the date of your first claim, we are able to accurately determine...

the timeline of any illnesses or accidents to ensure we are providing coverage to the fullest extent of the policy. With your first claim, we received medical records of your pet’s veterinary visit prior to enrollment. We reached out to you and your veterinarian to obtain medical records for any other veterinary visits after this date and through the date of the first claim. While the invoice submitted outlined the treatment your pet was given on that day, we did not receive medical records from your veterinarian outlining signs, symptoms, condition being treated, or treatment plan.The claim was closed due to the length of time it had been open and awaiting additional information. Though we were unable to determine coverage without receiving additional medical records, we are happy to review updated medical records and review your claim for reprocessing at any time.Our coverage is continuous until canceled. You may cancel your policy at any time and we ask that you notify us in writing 14 days before your next billing date. When we received your cancellation request, we provided a refund of the last two charged premiums.

Complaint: [redacted]
I am rejecting this response because: second payment shouldn't be prorated. When it was taking out on 4/5/2017 she passed on 4/2/2017. I notified healthy paws on 4/3/2017! If she wasn't going to be covered due to unforseen conditions during a waiting period. Then I shouldn't be charged for services dismissed by the events unfolding during this "waiting period"
Sincerely,
[redacted]

Healthy Paws provides coverage for any new accidents, illnesses, or accidents first showing signs or symptoms after enrollment and applicable waiting period(s). There is a 15-day waiting period for accidents and illnesses. Conditions first showing signs or symptoms prior to enrollment or during the...

15-day waiting period are excluded from coverage.Information about coverage and policy exclusions can also be found on our online FAQs, including access to a sample policy:https://www.healthypawspetinsurance.com/frequent-questionsThe waiting period for your policy ended on 1/26/2018. On 1/27/2018 medical records indicated your pet had been limping, potentially every day he attended day care. A follow-up visit on 4/10/2018 indicated that your pet was still limping and the signs and symptoms had been present for a few months. Upon initial review of medical records, these notes indicated the signs and symptoms were first noted during the 15-day waiting period. The policy excludes conditions first showing signs or symptoms within the 15-day waiting period.You reached out to us previously to discuss sending updated medical records indicating a clear timeline of signs and symptoms. Whenever, there is a dispute in coverage, we encourage our Pet Parents to submit additional information, that was not included when the claim was first submitted. We are always happy to review updated medical records or additional information from your veterinarian to determine coverage. To see if there was an opportunity to appeal for coverage, we reviewed the medical records again to confirm timeline of symptoms, enrollment and waiting periods. Though medical records from 1/27/2018 indicate the limping was noted for multiple days, the veterinary notes were unclear as to the specific timeline these signs or symptoms first began. Based upon the unclear timeline, we will appeal the claim and reprocess in the next couple of days. Thank you for your patience on this matter and we apologize for any inconvenience.  In regard to coverage for surgery, you must be enrolled for coverage. If you want to void your cancellation, please reach out to us in the next couple of days to continue your policy. We will send you a personal email confirming you want to reestablish coverage and collect payment.We hope your furry kiddo is feeling better, and wish him a smooth surgery and quick recovery.

Complaint: [redacted]
I am rejecting this response because:You make your argument that dental cleaning is not covered by referring to the exclusions for preventative and routine care. I signed up with Healthy Paws knowing that this routine and preventative care was not covered--this means I am prepared to pay for dental cleanings every other year at a low cost clinic as well as the standard shots and vet visits. It does not mean, however, that I should be prepared for covering dental cleaning for my ONE YEAR OLD car who requires extensive dental cleaning AS A FORM OF TREATMENT and not preventative care EVERY THREE MONTHS. This is a clear loophole and violation of the terms of the contract which claim total coverage for treatment and transparency of such coverage.My argument, which seems fairly self-explanatory, is that this form of treatment--for an unexpected and rare autoimmune disorder that does not originate in problem associated with normal and routine care--should not be categorized as "routine dental care." It is categorically different than routine and preventative care, serving a different function which is to remove an allergen that causes excessive inflammation and infection, and only occurs if a cat's body (and not simply their teeth) have an autoimmune response. Comparing this condition and its treatment to routine dental care is comparing apples to oranges. Your policy needs to account for this, otherwise you are advocating and advancing loopholes in legitimate treatment. Your company, indeed, has been inconsistent and confused on this matter, telling me on one hand that all procedures related to his stomatitis will be covered and then that cleaning will not be covered because it is NOT a form of treatment. Only after I prove that it is a form of treatment has Healthy Paws conceded this latter point. Clearly, there is confusion at your company, and I believe this confusion could be cleared by a simple clarification of policy: if dental cleaning is being used as a form of treatment for animals who are severely allergic to plaque and for whom the removal of this plaque can reasonably be expected to reverse their condition, then this treatment should be covered. A simple doctor's note should suffice. This shouldn't be an exception to a rule--it should be the rule. Clearly, Healthy Paws hasn't thought through their policy to ensure coverage for treatment for the disease, and I will continue to fight to correct what is an egregious loophole.  
Sincerely,
[redacted]

We are hoping that [redacted] asks the Revdex.com to remove this complaint from our company reviews because the information regarding the handling of this claim is inaccurate. When the Revdex.com complaint regarding the processing of a hiatal hernia claim was posted on July 27, 2016, we hadn’t processed the claim. Due...

the invoice amount and complicated nature of [redacted] sweet boy’s conditions, we requested that the treating veterinary hospital fax us medical records to be reviewed. Once we reviewed the history, we processed the claim on August 5, 2016, which was covered for any new conditions and a reimbursement check was mailed. We processed this claim fairly and within our policy guidelines.
If this review is not removed from the Revdex.com, for pet parents researching pet insurance, please understand that we work very hard as a claims paying organization. Our hands our tied and are unable to provide coverage for claims when any signs and/or symptoms, not a diagnosis, start prior to the policy effective date (enrollment) or during the waiting periods. No pet insurance company covers pre-existing conditions. Our claims determinations are based off of the information documented in the medical records and the Healthy Paws Policy.  We process claims for all pets according to the same standards set within the provisions of the policy.

Complaint: [redacted]
I am rejecting this response because:Your most recent response is incredibly frustrating and indicative of your company's egregious slight of hand. Your response has completely erased the fact that I am seeking TREATMENT for my cat, not simple dental cleaning. I get my dogs' teeth cleaning regularly, and have accounted for this cost, because it is PREVENTATIVE. I understand that your your policy excludes dental cleaning from coverage --but that is because, if you actually look at your policy, you categorize it under preventative care. I am not asking you to provide preventative dental cleaning for all pets--I am asking you to provide dental cleaning for animals who need it as treatment when it could cure their disease by eliminating the allergen (plaque) which is the source of inflammation. My ONE YEAR OLD cat's need for dental cleaning every three months does not serve the same function as preventative dental cleaning, and your policy has not accounted for this discrepancy. Instead, your responses over the past months have been ad hoc, forcing me to prove that cleaning is treatment and then when I do, then denying that this proof has any impact. AGAIN, YOU NEED A POLICY THAT COVERS TREATMENT FOR ANIMALS WITH AN AUTO-IMMUNE DISORDER, WHOSE CAUSE DOES NOT ORIGINATE IN THEIR MOUTH AND WHOSE TREATMENT, THOUGH HAPPENING TO COINCIDE WITH GENERIC PREVENTATIVE CARE, DOES NOT SERVE THE SAME AIM OR FUNCTION.  Your most recent response, and your inadequately crafted policy, completely ignores these nuances in animal health, which could easily be cleared up by providing coverage for animals with veterinary note of diagnosis and treatment. INSTEAD, YOU ARE BEING DISCRIMINATORY AGAINST ANIMALS WHOSE DISEASE MANIFESTS IN THEIR MOUTH AND YOUR DENIAL OF TREATMENT IS FORCING ME INTO REMOVING ALL MY CAT'S TEETH INSTEAD OF WHAT SHOULD BE A STRAIGHT-FORWARD TREATMENT PLAN. Your policy, as well as your customer service, public relations, and reading comprehension is downright shameful. Your advertised persona 'all treatment is covered' is a blatant falsification and your denial of treatment is a breach in contract. I will continue to fight you publicly and legally, and I currently have a groundswell of support (from vets, rescues, and other Healthy Paws clients) behind me to do so. I advise you to find a better defense than the incoherent one you are now peddling, as it will end up costing you legal fees and public goodwill down the line. 
Very angrily yours,
[redacted]

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. This company went ABOVE AND BEYOND to make this right. This is a company of integrity and I am happy to remove the complaint. We have always settled on my last claim and the company was incredibly generous. Sincerely, [redacted]

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] but would like to let the VP know that I initially spoke with a Healthy Paws Pet Insurance representative on November 9, 2016 at 1:45 p.m. and the female representative stated that I could only cancel through a link and she would email it to me.  This is how and why I received an email with the automated link; as a result, I emailed customer service to inquire about the cancellation date but no one responded nor did I receive a phone call back from Healthy Paws after leaving a message on November 29, 2016 at 9:06 p.m.  The attachments are herewith for the VP's review; meanwhile, I look forward to receiving my prorated refund of my pet insurance premiums, as this resolution is satisfactory to me. Sincerely, [redacted]
[redacted]Supporting Documentation Redacted by Revdex.com Staff[redacted]

Complaint: [redacted]I will never ever recommend anyone to buy pet insurance from healthy paws since it is definitely not a reputable company.  Are you a vet to conclude that coughing is a pre-existing condition?  Are you a vet to tell me that no cat cough in his/her life time?  Since you're not a vet, do not tell me about the pre-existing condition.  That is why a lot of people that I know, they do not buy pet insurance and now I totally understand the reason.  What makes you think I bring my cat to the vet after 10 month of having pet insurance?  I would have brought the cat to the vet from the day that the enrollment expired; not 10 month of paying the premiums.  It is a waste of my time to deal with this kind of nonsense.When I submitted my dental record, why did not I get contact from healthy paws about the ultrasound in the beginning?  Ultrasound was done to look at one of the extraction of the teeth that was done earlier before I adopted my cat.  Do not interpret something that is not there.  If you're not a vet, do not ever try to interpret something that you have no knowledge.  What..trying to refund me one month for pet insurance?  What a joke?  If I don't have faith in your policy, it should be started from the beginning thru up to date; not just one month.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

When there is evidence that a pet parent has/had insurance coverage with another pet insurance company, it’s part of our investigation process to determine coverage; the date coverage started and/or the date it was cancelled. The language in most pet insurance policies state that the first company...

you enroll with is considered your primary company. When filing a claim, when dual coverage is present, we must obtain the Explanation of Benefits (EOB) or Notice of Cancellation from the other insurers before claims can be processed.   In our policy on page 3 of 7 it states: ll. Exclusions & Limitations 5) Limitations d. We will not make any payments for any claims for which you are entitled to be paid under any other insurance except for any additional sum which is payable over and above such other insurance. In an attempt to process your claim we requested the Notice of Cancellation from your previous insurance provider to confirm dates of coverage. On 6/26/17 we received an email with a cancellation attachment from your previous insurer that listed inaccurate cancellation information. Once the error was identified, the correct documentation was sent on 6/27/17 and we processed your claim as outlined in the policy.   We hope your sweet girl is feeling better! Have a safe fourth holiday.