There are several possible reasons for a claim rejection, including but not limited to eligibility issues, missing documentation, or discrepancies in the information provided.
The specific reasons some or all of your claim was rejected can be found in your Wagmo account. Once you’re logged in, select “Claims” from the menu and then choose the claim in question. The portal will provide detailed information on why the claim was rejected.
We also send an email notification each time a claim is finished processing that includes any relevant rejection rationale.
Below, we've outlined a few of the more common reasons for claim rejection:
- Invoice not itemized: Invoice is for a total amount, or includes no pricing. Be sure that each service provided is listed individually on the invoice with it's associated cost
- Invoice does not show proof of payment: Invoice does not confirm that payment has been made for services rendered. Be sure that the invoice includes payment made, as Wagmo policies are reimbursement based. Please provide proof of payment if the invoice shows a balance due.
- Invoice for wrong pet/no name listed: Be sure the invoice shows the name of your pet and that the claim is submitted under the correct pet in Wagmo. Whenever possible, submit separate claims for each pet if you have several furry friends.
- Invoice date outside of coverage window: Invoice is for a date during which your pet was not covered (pre-plan).
- Service for emergency or injury care: Wagmo Wellness only covers preventative care, so if the reason for your vet visit was an emergency need, it will not be covered by your Wellness plan.
- Max utilization limit reached: Wagmo Wellness plans have both reimbursement and utilization caps, which you can learn about here. In essence, if you have a utilization cap of two vaccines, for example, any vaccines after the first two will not be reimbursed.
- Item not covered: An item or service on the invoice is not something covered under your Wellness plan.