Pet Insurance Denied Claim: Getting the Help You Need

If your pet insurance claim is denied, don't panic. It's not uncommon for claims to be denied, but there are steps you can take to get the help you need.

You have the right to appeal the decision, and understanding the reasons behind the denial is crucial. Review your policy documents and the denial letter to see if there are any specific requirements or exclusions that may have led to the denial.

Your insurance company may have a designated appeals process, which can take several weeks or even months to complete. Be patient and stay on top of the process to ensure your appeal is properly reviewed.

You can also consider seeking outside help, such as a pet insurance advocate or a lawyer specializing in insurance law. They can help you navigate the appeals process and ensure your rights are protected.

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If your pet insurance company denied your claim, don't panic. Each company has a dispute resolution process that you can follow to resolve the issue.

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You can start by reviewing your policy and looking for the section on duties or claims filing to determine your next steps. If you disagree with the denial, you can also call your pet insurance company to request a review or ask how you can dispute their findings.

Most policies require you to go through the internal review process before taking other actions. This provides an opportunity for a different claims adjuster or supervisor to take a look at your claim and the circumstances for denial.

The reason for your denial should be clearly stated, and it should reflect one of the exclusions to your policy. If the review is not in your favor, you can file a complaint with your State Department of Insurance, which is free and can help you get to the bottom of the issue.

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You can start by asking your pet insurance company to review the claim, which is a common first step in dispute resolution.

Each company has a dispute resolution process, so look at your policy under duties or claims filing to determine your next steps.

You can also call your pet insurance company to request a review or ask how you can dispute their findings.

Most policies require you to go through the internal review process before taking other actions.

The reason for your denial should be spelled out clearly, and it should reflect one of the exclusions to your policy.

If the review is not in your favor, you can file a complaint with your State Department of Insurance, which is free and can help gather facts and determine if coverage exists.

Your state can make inquiry to your pet insurance company, obtain a copy of your policy, and make a determination of whether coverage exists for your claim.

If you're still not satisfied with the outcome after the internal review process and your state's review, you may try the company again at a higher level or seek legal action, which will be at your cost unless you prevail.

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Sending a demand letter to a pet insurance company can be a crucial step in resolving a dispute. It's a formal communication that shows you're serious about resolving the issue.

A demand letter can serve as a record of your attempt to settle, which can be used as evidence in small claims court if needed. This is especially important if you're seeking money for a claim that was improperly denied.

Sending a demand letter signals to the pet insurance company that you're not willing to give up on resolving the dispute. It's a way to show them that you're willing to take action.

By sending a demand letter, you may be able to resolve the dispute without having to take legal action or pay court costs. This can save you time, money, and stress in the long run.

Here are some key benefits of sending a demand letter:

Pet insurance is often misunderstood as being a one-time fix for denied claims, but the reality is more complex.

A denied claim doesn't necessarily mean you're out of luck, especially if the reason for the denial was a pre-existing condition.

In some cases, a condition might be considered pre-existing or bilateral, which means it wouldn't be covered even with a different carrier.

Pet owners like Rub and Thomas Kelly from Wilmington, Delaware, learned this the hard way when their claims were denied by Trupanion.

They disputed the pre-existing condition claims, but it took the involvement of the Troubleshooters and Action News to get a different answer from Trupanion.

Trupanion actually pays out over $2 billion to its members and their veterinarians, and they consult with veterinary teams to ensure fair claims decisions.

However, before you sign up for a new policy, be aware that you'll be notified of any pre-existing conditions that won't be covered.

A denied claim can be frustrating, especially if it's due to a pre-existing condition. Pre-existing conditions are conditions that existed before you purchased the policy.

It's possible that a condition was denied because it was considered pre-existing or bilateral. Bilateral conditions affect both sides of the body.

Chances are, if you switch to a different carrier, those conditions wouldn't qualify for coverage either. This is because insurance companies often have similar policies.

Any new conditions or injuries your pet experienced while being covered by a previous carrier would be considered pre-existing by a new carrier. This can make it difficult to find a new policy that covers your pet's needs.

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Trupanion, a pet insurance company, offers a 90% coverage of all claims, but this didn't happen for two dog owners who turned to the Troubleshooters for help.

Their claims were denied because Trupanion said the conditions were pre-existing, but the owners dispute this.

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To process claims, Trupanion consults with the veterinary team to ensure their decision is fair and appropriate.

The company has paid out over $2 billion to its members and their veterinarians.

With over 150,000 veterinary invoices paid every month, Trupanion is a large player in the pet insurance market.

Trupanion claims to pay reimbursements directly to the veterinary hospital in real-time, 24/7/365.

In the case of the two dog owners, the Troubleshooters were able to help them get a different answer from Trupanion after months of going in circles.

The owners were able to get their reimbursement after the Troubleshooters intervened, including Rub, who said it was "really literally unbelievable" when Trupanion agreed to pay for her pet's surgery.

Filing a complaint against a pet insurance company can be a daunting task, but it's often the best way to resolve a denied claim.

Start by reviewing your policy documents to understand the reasons for the denial. In many cases, the insurance company will provide a clear explanation of why your claim was denied, as seen in the example of Emma's denied claim due to pre-existing condition.

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You have the right to appeal the decision, and most pet insurance companies have an appeals process in place. This process typically involves submitting additional documentation or evidence to support your claim.

Keep in mind that the appeals process can take several weeks or even months to complete, as seen in the example of Sarah's appeal taking 6 weeks to be processed.

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Claim Submission can be a straightforward process if you're aware of the time frame. Petcover allows you to submit a claim within 12 months of your vet's invoice date.

If you miss this deadline, your claim will be denied. Don't wait too long to submit your claim, or you'll risk losing out on reimbursement.