Healthy Paws Pet Insurance LLC

Pre-existing conditions can be very frustrating not only to pet parents but for us too. As a claim paying organization, we’re disappointed when we find notations in the medical records that indicate that conditions occurred prior to enrollment or during the waiting periods.  Our claims...

determinations are based off of the information provided by you or your veterinarian and the Healthy Paws Policy including when the signs and or symptoms presented, not when a condition is diagnosed. Here’s a timeline of the notes in the medical records and policy events: 11/21/2016 Exam for spot on ear that has been there for a few days. Your veterinarian was ruling out abrasion vs a growth in which they recommended to monitor for inflammation or persistence. 4/23/2017 You sent an email to Healthy Paws inquiring about coverage and pre-existing, specifically a small bald area, concerns of alopecia and if cancer would be covered in the future. We informed you that could not provide follow up care to the alopecia that was noted. There were no questions in the email referencing a growth on the inner ear. 4/24/2017 You enroll with Healthy Paws with a policy effective date of April 25, 2017 at midnight. 5/10/2017 Waiting Period ends for accidents and illnesses 5/12/2017 Claim service date for growth on right inner ear. Medical records note that the growth has been there for 6 months and is growing. Claim was denied due to pre-existing. Since the signs and/or symptoms of the growth were present prior to enrollment, we are unable to provide coverage. No pet insurance covers pre-existing conditions. As noted in our policy page 2 of 7:  II. EXCLUSIONS & LIMITATIONS  1) GENERAL EXCLUSIONS  We do not cover:  2) PRE-EXISTING CONDITIONS  We do not cover pre-existing conditions.  Pre-existing conditions means:  a. illness or the recurrence of any illness or condition which first occurred or displayed any signs and/or symptoms consistent with the stated illness or condition prior to the pet policy effective date;  b. an injury or recurrence of an injury that occurred prior to the pet policy effective date; or  c. any condition or complication resulting from an illness or injury that occurred prior to the pet policy effective  date.  We hope your sweet boy is recovering well from his surgery.

I’m sorry to hear that you’re frustrated with pet insurance. Based upon your feedback, you were upset that our policy did not cover treatments for your pet on 7/5/2016, 7/7/2016, 7/12/2016 and 8/5/2016. Please understand that we are unable to provide coverage for any services rendered prior to your...

policy effective date of 7/13/2016. No pet insurance company would reimburse treatments before a pet was enrolled for coverage.
In regard to the claim submitted for services on 8/5/2016, all of the charges on this invoice were related to wellness and preventative care and our policy provides coverage for treatments related to accidents, illnesses or injuries. Our policy provides coverage for diagnostic testing such as blood work, x-rays or CT scans, hospitalization, surgeries and prescription medications for any new signs or symptoms of illness or injury that occur after enrollment and waiting periods.
As outlined in the policy, we do not cover preventative care. These expected costs such as vaccines, flea control, deworming etc. are not covered on the policy and is the pet parent’s responsibility. You can find this information in our policy and our website.
Page 2 of the policy:
II. EXCLUSIONS & LIMITATIONS
3)  PREVENTIVE CARE EXCLUSIONS
We do not cover:
a. Spaying and neutering.
b. Preventive healthcare including vaccinations or titer test, flea control, heartworm medication, de-worming, nail trim, and grooming.
c. Parasite control including but not limited to internal and external parasites for which readily available prophylactic treatments are available.
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.
e. Anal gland expression.
On 8/29/2016 you successfully canceled your policy using the online Customer Center.

Dear [redacted], I understand that you’re frustrated with the process, because your claim was uncovered due to a pre-existing condition. If the coughing signs did not present prior to the policy effective date, we would have covered the claim. It’s disappointing to us too when there are notations in the...

medical records about pre-existing conditions. We’d much rather cover claims than have pet parents frustrated with the process. Before I started working for Healthy Paws, I didn’t understand that all insurance companies must follow the same rules and guidelines for their policyholders. It would be discriminatory if we didn’t. For our pet parents, this pertains to our policy including coverage and cancellations. What was offered to you is the same as what we would extend to other pet parents. In my response to your original Revdex.com compliant #[redacted], I stated: “we will refund your premiums to the date after your claim invoice service date.” On 3/7/2017 we issued you a refund with your policy cancellation effective 2/16/2017, which was one day after the invoice service date was 2/15/2017. Here’s the policy information regarding pre-existing and cancellations: II. EXCLUSIONS & LIMITATIONS 2) PRE-EXISTING CONDITIONS We do not cover pre-existing conditions. Pre-existing conditions means: a.  illness or the recurrence of any illness or condition which first occurred or displayed any signs and/or symptoms consistent with the stated illness or condition prior to the pet policy effective date; b. an injury or recurrence of an injury that occurred prior to the pet policy effective date; or c.  any condition or complication resulting from an illness or injury that occurred prior to the pet policy effective date. III. GENERAL CONDITIONS 2)  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. Again, I’m sorry for your frustration and hope that all is well for you and your kitty. All the best, Jen

I’m sorry to hear that your kitty has stomatitis. I‘m quite familiar with the medical condition, because I have a kitty that has the stomatitis too and my background is in veterinary dentistry. As you described, the primary treatments for stomatitis are partial extractions with routine dental...

cleanings or full mouth extractions. The first course of treatments typically starts with partial extractions, a dental cleaning and sealants. If there are no improvements of the inflammation, a veterinarian will recommend full mouth extractions. We process claims using the same policy provisions for all of our pet parents, meaning that we are consistent with our coverage from one Pet Parent to another. As stated in our policy, we do not cover dental health care, particularly dental cleanings or prophylaxis, which is why we did not cover this line item from your kitty’s claim. You can find this information outlined on our policy, on page 2 of 7: II. EXCLUSIONS & LIMITATIONS 3)  PREVENTIVE CARE 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. 4)  OTHER EXCLUSIONS I.       Claims in any way arising from the lack of use and/or implementation of preventive healthcare products and/or methods when such products and/or methods would be in accordance with generally accepted veterinary standards. Routine healthcare includes: vaccinations, flea control, heartworm medication, de-worming, dental care, ear plucking, grooming, and prudent regular care; V. DEFINITIONS 10)  Dental Health Care. The regular care required to maintain dental hygiene for your pet. This includes brushing, scaling, polishing, extractions and reconstructions. For the claim in question, we covered the treatments as outlined in our policy. We covered the pre-anesthetic blood work, dental x-rays, hospitalization, fluids, anesthesia, surgery, histopathology, pain relievers and prescription medications. The two line items that were not covered on this claim were the Exam Fee and the dental cleaning. Anyone visiting our website can see this information on our “Benefits, Coverage and Exclusions” page. By making preventative care (which includes routine dental care) part of the pet parent's financial responsibility, it allows us to offer a complete accident and illness plan at an affordable monthly premium. Our policyholders value comprehensive coverage and unlimited benefits at reasonable rates. I hope this clarifies your concerns and that your kitty is feeling better after his recent treatments.

I’m very sorry to hear that your dog was not feeling well and required medical treatment.  The claims determinations are based solely off of the information provided by you or your veterinarian and the Healthy Paws Policy.  Our coverage is based upon when the signs and or symptoms...

presented, not when a condition was diagnosed. We process claims for all pets according to the same standards set within the provisions of the policy.  
After reviewing your claims, medical records and veterinarian’s letter, the first signs and symptoms of the conditions were noted during the 15-day waiting period. This is the reason why we were unable to provide coverage for these claims. As noted in our policy:
II. EXCLUSIONS & LIMITATIONS
1) GENERAL EXCLUSIONS
We do not cover:
c. Illness that occurs or recurs within the first fifteen (15) days following the pet policy effective date.
When we processed the claim on June 10th, we sent you an email with the specific dates and notes from the medical records that supports why we were unable to cover these claims.  Even though we are unable to cover the identified condition that occurred during the waiting period, your Healthy Paws Pet Insurance policy covers the cost of the veterinary treatment related to an accident, illness or injury where the clinical signs or symptoms were first present after the enrollment date and waiting periods.
We hope that your sweet boy continues to feel better.

I’m sorry to hear that you were frustrated with the recent events with your account. I understand that you’ve spoken with one of our managers to learn more about why the second pet who was enrolled in March received a premium increase in July. I would be happy to provide additional...

clarification.
Your policy anniversary date is when your policy or account was originally created. This is when you enrolled your first pet with us in July. Every year upon your anniversary date, you may receive a premium adjustment to keep up with the rapidly rising costs in veterinary care in your area. Although you enrolled your second pet in March, your account anniversary date is when you enrolled your first pet. This is why there was a premium increase in July for both of your pets. Next year, we will review the premiums in your area for both of your pets in July.
We communicate any policy changes to all policyholders via email. We have confirmation that an email was sent to you regarding your anniversary premium increase and confirmed that it was sent to the email address we have on file. Based upon your complaint, it sounds like you didn’t get an opportunity to review it. As discussed earlier, with one of our managers, in an effort to show transparency and as a gesture of good faith, we are sending you a gift card for the lack of received communication regarding the premium increases. 
We strive for complete transparency and based upon your recommendation, we will add additional messaging to our website for Pet Parents who are adding a pet to their account about the annual premium increases so that there are no misunderstandings. Thank you for taking the time to work with us and improving our website messaging.
Wishing you and your family happy holidays!

Dear [redacted], I’m being genuine when I send my condolences. As a mutual pet parent, I understand the heartache you are going through from the loss of your sweet girl, [redacted]. Timing with insurance is very important. As I outlined earlier, the signs and symptoms that presented prior to enrollment and during the waiting period are the reasons why we were unable to provide coverage. Sincerely, Jen

Dear [redacted], I’m so sorry that your account wasn’t canceled earlier. When I researched your account, I did not find your written request to cancel, which is why your account was still active. We need to receive a written request to cancel the policy or you must complete the cancellation process...

online from your Customer Center. I’ve confirmed that your account has been canceled, a pro-rated refund was issued to your credit card on file and a gift card was sent to your home address for your inconvenience. Please let us know if you have additional questions. Sincerely, Jen

We are delighted to hear that your English Bulldog is in excellent health! This is great news, as we like to hear that our pups are happy and healthy. We know that it’s stressful when your pet is sick or injured. We’re here to protect your pet and give you peace of mind if you ever need us!
Based...

upon your feedback, it sounds like you’re frustrated with the premium increase you received with your recent address change. Understandably so, as I wouldn’t be happy with a premium increase, but let me take a moment to explain how premiums are factored to help you better understand the increase. Our premiums are based upon 3 factors:
·       Pet breed
·       Age at the time of enrollment
·       Zip Code
When your zip code changed, your premium changed to reflect the rates in your area. Premium base rates are consistent with all pets that are enrolled in that zip code. Based upon insurance regulations and guidelines, we must be fair and consistent with premiums in your area. With address changes, premiums may increase or decrease based upon cost of veterinary medicine in the area. I hope this clarifies your questions about your premium increase due to address change.

Pre-existing conditions can be very frustrating not only to pet parents but for us too. As a claim paying organization, we’re disappointed when we find notations in the medical records that indicate that conditions occurred prior to enrollment or during the waiting periods.  Our claims...

determinations are based solely off of the information provided by you or your veterinarian and the Healthy Paws Policy.  Our coverage is based upon when the signs and or symptoms presented, not when a condition was diagnosed. We process claims for all pets according to the same standards set within the provisions of the policy.  We understand that you feel that we should review symptoms by species, but we base all of our claims determinations on the notations written in the medical record for the individual pet.  In your kitty’s medical records, it’s noted that he “presented for coughing. Since taking over ownership he has always had a cough, sounds almost like hacking up a hairball, particularly after he has been on his back.” Since these signs or symptoms were noted to begin prior to his enrollment, we are unable to provide coverage for these conditions.  No pet insurance company covers pre-existing conditions. As noted in our policy: II. EXCLUSIONS & LIMITATIONS 1) GENERAL EXCLUSIONS We do not cover: 2) PRE-EXISTING CONDITIONS We do not cover pre-existing conditions. Pre-existing conditions means: a. illness or the recurrence of any illness or condition which first occurred or displayed any signs and/or symptoms consistent with the stated illness or condition prior to the pet policy effective date; b. an injury or recurrence of an injury that occurred prior to the pet policy effective date; or c. any condition or complication resulting from an illness or injury that occurred prior to the pet policy effective date. Since you did not find value in our policy, we will refund your premiums to the date after your claim invoice service date. We hope your kitty is feeling better.

Complaint: [redacted]I am rejecting this response because:
Your calculation of reimbursable amounts fails to follow standard insurance guidelines.  The practice is misleading. You define "deductible" as the amount "you must first pay" which directly contradicts the remainder of your definition.  if coinsurance is applied first, the deductible is not first. Calculating coinsurance first is a deceptive way for Healthy Paws to pay less in reimbursments.
Sincerely,[redacted]
You could say something like
Your calculation of reimbursable amounts fails to follow standard insurance ______ (guidelines, policies, it's misleading, etc). Deductible is described as the amount you pay first which is a contradictary statement.  If coinsurance is applied first, then the
deductible isn't first.  Calculation of coinsurance first is a deceptive way for Healthy Paws to pay less in reimbursements
You could say something like
Your calculation of reimbursable amounts fails to follow standard insurance ______ (guidelines, policies, it's misleading, etc). Deductible is described as the amount you pay first which is a contradictary statement.  If coinsurance is applied first, then the
deductible isn't first.  Calculation of coinsurance first is a deceptive way for Healthy Paws to pay less in reimbursements

Dear Revdex.com,
I believe there was a misunderstanding of our cancellation process, which is completely computer automated. Here's how the cancellation process works:
As stated in our policy, on Page 3 of 7, “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.
When a Pet Parent requests to cancel their account, they can cancel by either sending us the request in writing or by completing the process online. If the cancellation is completed online, the Pet Parent completes the cancellation request by clicking a link to confirm the cancellation and our automated system cancels the account. Next, an email is sent to the Pet Parent with the Notice of Cancellation and instructions on how to reach us if they need additional help or want to provide feedback.
In [redacted]’s situation, the email responses she sent on November 29th requesting to cancel immediately were sent to an automated email system. This is why she did not receive a response from a Healthy Paws Customer Care Representative. One of our team members would have been happy to help her with her requests.
I have sent an email directly to [redacted], explaining these details and we are working on the prorated refund. We have settled this compliant as she requested. Please consider removing this complaint from our record.
Thank you,
Jen