YOU ASK:

What to do when a pet health insurance company denies a claim?

WE ANSWER:

Well, you can try to make an appeal to the insurance company who denied the claim.

There are some times when a claim is denied because there is insufficient information, the insurance company felt that the amount being claimed is too high compared or there is a dispute on the fact that the medical treatment is for an illness of injury that is not covered.

Before you panic and start considering filing a lawsuit on the insurance company, here are some things you can do:

  • Ask the insurance company for the reason why they denied the claim. Get this in writing. That way, you can easily check their reason for denial and the policy provisions. You should also record all phone conversations with them and to keep the records of your e-mail communications with them. You can use these later on as support, especially if the insurance representative promised you something.
  • Read your policy's terms and conditions. Denied claims usually state pre-existing conditions as the reason for their denial of your claims. You can try to dispute the reason if you know what your pet insurance policy contains.
  • Review the documents you submitted. Are these enough to prove the validity of your claim? Do you need to submit more receipts, reports and other supporting documents?
  • Speak to your veterinarian. Ask how the medical reports can be resubmitted so that it complies with the requirements of the pet insurance company.

The next time, when you file a claim, do so as soon as you can and also have copies of the documents you submitted.

Some pet insurance companies also allow you to send your complaint about your claim to a third party for review. The third party is usually composed of veterinarians who will also review the claim, the medical treatments provided, and will determine whether these medical treatments are covered under the policy.

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