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Appealing a Pet Insurance Claim: Max’s Story

dog in the snowOur story is one of customer service that began when we took Max in for a routine Vet visit to get some shots. While we were there we asked the same question all pet owners do, “how’s he doing?” The Vet told us he was fine, but that we needed to be careful to watch for elbow issues as this is more common in large breed dogs. That comment got annotated in Max’s file.

A couple of months later we took Max in again because it looked like he was favoring one of his legs. That led to a series of X-rays and CT scans and a recommendation for elbow surgery. Our claims for reimbursement were rejected because of the note in Max’s file related to elbow issues mentioned earlier. While I understood how someone reviewing claims could easily make that determination, I also felt that it was in error so I contacted Trupanion and began the conversation about how to request a review of my claim. I submitted a clarifying letter from Max’s Vet and formally requested an internal review of the claim denial.

I was happy to hear that the review team changed the initial decision to deny my claim based on an existing precondition and promptly reimbursed 90% minus the deductible! I have to say that through the entire process every single person that I had contact with was friendly, professional and displayed a sincere concern for Max’s well-being.  We are a Trupanion believer. Thank you!

Michael Wolfe, Max’s Dad

PS We got a second opinion about the surgery and decided to let him grow into himself for a few more months and then take another look to see how he’s doing.

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