- 4 years ago
- Wedding: November 2012
(Apologies for the formatting weirdness)
I signed up with Trupanion a couple months ago because I heard from other dog people that they have a superior level of costumer service. However, they’re already hassling me about my second claim with them. To make a long story short, I’ll put this in timeline form.
<br /> <br /> Feb. 10: I sign up for the policy. Given my dog’s unknown history as a rescue we found as a stray, the salesperson assured me that in the event he has a condition or illness that we don’t yet know about, it would be covered so long as the symptoms and diagnosis occur after the one-month waiting period following the enrollment date. I specifically asked about it. “What if he has a horrible disease and we just don’t know about it yet and he doesn’t display symptoms until months from now but it turns out he’s had the disease for years?” The answer I got was that it would be covered in this case. After signing up, I read the policy document and saw nothing to contradict that statement.
<br /> March 10: 30-Day waiting period is done. The policy went into full effect.
<br /> March 23: Vet visit. My dog had been very active a couple days prior and started exhibiting signs of pain the day before. When the vet filled out the claim form, he noted the date that symptoms first appeared as March 23, 2014. This is well after the policy was in full effect. Vet told me to keep my dog on rimadyl for a couple weeks, limit his physical activity, and follow up in two weeks if the pain still persisted.
<br /> March 28: Trupanion sent me an e-mail notifying me that the claim was approved. It included the following statement:
<br /> Thank you for the recent submission of the claim for Pete’s treatment. We have approved the claim, and applied the amount to your deductible. Once your deductible has been met, we will pay all future eligible claims for this condition.
<br /> April 4: The pain still persists, though the rimadyl seemed to take the edge off. We take Pete back to the vet and they did x-rays. Turns out that his hips had been fractured at some point a long time ago and just happened to heal in such a way that left him mobile and able to defecate properly. Very upsetting, but the mystery was solved. We submitted the claim.
<br /> April 10: Trupanion notified me that they denied the claim.
<br /> • 04/04/14- “Spinal and pelvic survey radiographs- L5/6 have degenerative changes/osteophyte proliferation, pelvis demonstrates misalignment /rt [right] acetabulum displaced medially and enlarged/lateral displacement of rt wing of the ileum, bony proliferation also noted in these regions. Old pelvic/lower spin injury and significant secondary OA [osteoarthritis]/degenerative changes. “<br /> As these notations indicate the onset of the condition began prior to enrollment, there can be no coverage for this claim.<br />
<br /> Please refer to the following policy exclusion(s):<br /> 7.b.1 Illnesses for which any evidence and/or symptoms of their potential manifestation already exist at, or prior to, the policy enrollment date<br /> 7.e.8 Diagnostic tests for conditions or procedures excluded by this policy and/or due to complications of conditions excluded or restricted by this policy
<br /> I also went back over my policy contract last night. Read the bolded byline carefully. Take another look at my timeline. At or prior to the policy enrollment, there was no evidence or symptoms of Pete’s condition. Symptoms appeared on March 23rd and the diagnosis occurred on April 4. According to this byline, we should be in the clear and the condition should be covered because there were no symptoms or evidence of it prior to March 23rd.
<br /> Their argument? “Even though the evidence for the condition showed up after the policy took effect, it is not covered because the evidence shows that the condition predates enrollment. It’s obviously an old injury.”
<br /> Clearly, some claims adjuster at Trupanion is trying to redefine the English language by applying byline 7.b.1 to that argument. I’m an attorney. I pick apart contracts for a living. This is an illness/condition for which no evidence and/or symptoms of its potential manifestation already existed at, or prior to, the policy enrollment date. It’s actually quite pathetic that their ammunition is the very clause which flies in the face of their reason for denial. You’d think that an insurance would be better at trying to weasel out of paying up for a claim, given how notorious they all are about playing these games.
<br /> My “liason” at Trupanion “sees my point” and she brought it to the attention of the appeals department, and they agreed to take another look at the case. I’m hopeful that this will lead to a resolution because it’s supposedly handled by a different claims adjuster going forward.
<br /> Has anyone else had trouble with Trupanion? Any similar experiences with pet health insurance companies? Everyone raves about how wonderful and easy to deal with they are. I’m pretty shocked that they dropped the ball on this one and are trying to pull one over on me because they’re apparently the company that doesn’t jerk its costumers around like this.