You deserve a claims experience that is transparent and fair
Submitting claims to insurance companies can seem scary to some people. Often, you may not know how your claim is being reviewed or why it is eligible or ineligible.
To help you feel comfortable with Trupanion’s claims process, and because we want to be the most transparent pet medical insurance company, we're providing an inside look into our claims experience. When Trupanion members see this system of checks and balances we have in place, they feel confident submitting invoices.
THE CLAIMS EXPERIENCE
If your veterinary hospital partners with Trupanion to offer Vet Direct Pay, they can submit your invoice for you.
If your veterinary hospital does not yet offer Vet Direct Pay, you or someone at your veterinary hospital can submit invoices in one of two ways:
All you need to open a claim is:
- Your complete itemized invoice
- Your pet's name,your name, your phone number, and your email address
- The veterinary hospital's name, the name of the treating veterinarian, the purpose of your visit (or diagnosis)
If you aren’t sure if something is eligible for coverage, there’s no harm in submitting your invoice and seeing the outcome. However, there are some specific things that our policy will not cover:
Terms and conditions apply. See the full policy for details
Once your invoice is submitted, it goes to a Trupanion data assistant who looks over your submission and confirms that all of the required fields are present. If we’ve been paying similar claims for you in the past, your claim will go to a special team for quick review. This helps us process nearly 60% of claims within 24 hours.
What you can do to speed up this process
- Submit your invoice as soon as possible. The sooner you submit your invoice, the sooner your claim can be reviewed.
- Request that your veterinary hospital work with us directly to file your claims. The more claim information and medical history we have, the faster and easier it should be to close your claim.
Next, we work with your veterinary hospital to collect your pet’s medical records. Once we have your pet’s medical records, your claim goes to a Trupanion claims specialist.
Pet health care is very different from human health care, so we require all of our claims specialists have:
- An exceptional understanding of veterinary medical terminology and medical conditions
- 3+ years of veterinary technician or assisting experience in a hospital environment with preference given to candidates with 5+ years in a hospital environment and/or licensed technician credentials
The claims specialist will go through your pet’s medical records, policy notes, and claim information to determine claim eligibility. They may even reach out to your veterinarian for further clarification.
What you can do to speed up this step
- Confirm your contact information in your online account so our claims specialists can clear up any questions as soon as possible.
Once our claims specialist has reviewed your pet's medical records they will determine if your claim is eligible or ineligible, and the claim is marked as "closed" in our system.
Regardless of the outcome, you will receive an email with an explanation of our decision and an itemized breakdown of your claim. This information is also added to your online member portal.
If your claim is eligible, your claim will be paid in one of three ways:
- Your veterinarian will be paid directly if they accept Vet Direct Pay (so you’re never out of pocket for our portion of the bill)
- You will be paid directly into your bank account (if we have that information on file)
- You will be mailed a check
If your claim is ineligible, it is probably due to one of these factors:
- Your claim was for a direct policy exclusion This is the most common reason why claims are ineligible. See Step 1 of this page for examples of direct policy exclusions
- Your claim did not have all of the necessary paperwork If this is the case, we can easily reopen your claim once you've provided all of the necessary paperwork.
- Your claim was for a pre-existing condition Our goal is to be transparent, so here’s a reminder that our policy isn’t designed to cover the things that happened before you became a member and your coverage kicked in. If your claim was for a pre-existing condition, we will email you more details to help you understand the reason for ineligibility.
Just because we mark a claim as “ineligible” doesn’t mean it can’t be appealed.
We believe in a fair claims experience that includes a system checks and balances. That's why members can easily appeal if claims are marked as ineligible for being a pre-existing condition. Your veterinarian can reach out to our customer care team 24/7 to discuss your claim outcome and the appeals process.
The appeals experience is very thorough. Our dedicated Trupanion appeal team, all with extensive veterinary backgrounds, will carefully reassess your claim at no additional cost to you. These are the steps of our appeals experience:
- Ask your veterinarian to call in or fill out an appeal letter elaborating on their medical records and explaining why the claim should be approved.
- We reopen the claim in our system, assess eligibility, and reach out to other managers and veterinarians when help is needed.
- We’ll follow up with you to provide updates on your appeal. Since this process is so detail-oriented and methodical, it could take around one month to finalize an appeal.
- After reviewing all of the information, we’ll send you a written explanation of your outcome and you can call us any time with further questions.
If your claim is marked as ineligible again, you can call us 24/7 to discuss the appeal decision.
We have this extensive system of checks and balances in place, because we're humans and sometimes we make mistakes. Yet, we never want to get anything wrong when it comes to helping cats and dogs. We offer this simple, reasonable, and fair claims experience all to help pets receive the best medical care possible.
If your veterinary hospital accepts Vet Direct Pay, your invoice is submitted on your behalf and paid out directly to your veterinarian in as little as 5 minutes.
For critical claims and critical appeals, we expedite our claims process so you know your coverage options faster.
The people behind the claims process
Members are most surprised when they realize there are people, not machines, behind their claim outcome. Our claims team loves helping cats and dogs get the care they need. We truly enjoy paying out claims to responsible pet owners and hearing how our product is making a difference in the lives of pets.
Role: Claims Adjudication Specialist
Pets' names: Gibson, Kegan, Benson, Mylee, Marley, Sprocket, Baby Wallingford
CLAIMS SPECIALIST OF THE MONTH
What I wish people knew about the Trupanion claims process:
“The claims experience is set up to be simple! We want to keep things as streamlined as possible, and we also want to thoroughly assess a condition. Sometimes it means we need to place a follow up call, other times it means we need to collect additional medical records, but each claim is given our undivided attention. Our drive to help pets translates into how we process claims.”
Why I love Trupanion:
“In Trupanion, I found more than just a job, but a family and home. For as long as I can remember, I wanted to work as a vet tech. When I was no longer able to work in practice due to various health issues it felt like I lost part of myself. Today, while I may not be on the floor taking care of my patients, I get to surround myself with my dogs and cats, and help our members and their beloved pets. I love putting our members’ minds at ease by alleviating part of the financial burden that can come with unexpected health care costs, and I love that Trupanion gives pet parents the freedom to choose the best care for their beloved pets. I’ve had a lot of experience in human health insurance and love how user friendly our policy is and how our team always goes the extra mile. Trupanion encourages us to be true to our unique selves, and because of that we have a truly collaborative environment where we are all working together towards the common goal of helping pet’s receive the very best care.”
AMETHYST | BROOKLYN, NY
Read Amethyst's story
Read Amethyst's story
“Amethyst was only 9 weeks-old when tragedy struck. We thought we had a healthy puppy when suddenly, she couldn’t breathe and we had to rush her to the emergency hospital. Her veterinarians told us that she had fluid and blood in her lungs. Amethyst had to be put on a ventilator—we weren’t sure how long she would need this intensive care. Already having stayed at the hospital and now in need of surgery, you can imagine the medical bills we received. Thankfully, we had enrolled in a Trupanion policy the first day we took Amethyst home. They were there for her no matter what—they even paid directly to the hospital! Out of a $64,000 claimed veterinary bill they covered the eligible $57,000 and truly have no limit. They made this a little easier financially and even checked up on her. I wouldn’t have my Amethyst if it wasn’t for Trupanion.”
COLE | GLENSIDE, PA
Read Cole's story
Read Cole's story
“This past April, I received terrible news when my 8 year old blue point Siamese, Cole, was diagnosed with nasal respiratory carcinoma. This is an aggressive type of cancer with no cure – the only treatment is radiation. Without treatment, Cole’s future would have been very short. Thankfully, I had Trupanion insurance for Cole. Without it, I would not have been able to afford his costly treatment. Trupanion has been extraordinary! All my claims have been paid quickly and without issue. The Trupanion representatives are extremely friendly and caring, always making a point to ask how Cole is doing. Cole has completed his radiation treatments and is doing extremely well. I realize that his days are numbered, but I am optimistic that his days will stretch into months or even possibly a year or more. I am so grateful to Trupanion for this extra time with Cole; I am cherishing each and every day with one of the best friends I’ve ever had. Thank you, Trupanion!”
HOLLY | MAGNA, UT
Read Holly's story
“Holly is my hero; she is my retired seizure alert and response service dog and has saved my life many times. She truly is my life and I can’t imagine my life without her by my side. A few weeks before Holly’s 16th birthday she took a turn for the worse and started showing neurological signs that something was very wrong. Because of Holly’s policy with Trupanion we were able to do a CT. When it came back we learned that she had suffered a major stroke and a couple smaller strokes before that. Because of that information, we were able to get her on aspirin to prevent a future stroke and were able to make the decision to give her brain time to heal. Trupanion has helped us with Holly’s medical expenses from kidney disease, pancreatitis, arthritis, high blood pressure, stroke and several near-death medical emergencies. Trupanion is always fast with processing the claims and is always so kind and knowledgeable when I call with a question. Thank you, Trupanion, for taking amazing care of my hero and helping me save her life, we could not have done it without you!”
Shanna and Cindy W.
Trupanion was founded to help end economic euthanasia and make sure cats and dogs can get life-saving care when they need it. Our devotion to pets and pet owners is why we offer this transparent claims experience that helps ensure legitimate claims are never denied. The vast majority of our employees are loving pet parents themselves, and they celebrate paying large claims by ringing a bell in the office!
At the end of the day, when we review claims we want to be fair and helpful to pets, pet owners, and veterinarians. We agree with veterinarian Andrea Crabtree, when she says pet owners, “need empathy, support, and to count on someone who is on their side when they need it most, and Trupanion does that.”