Wagmo Wellness Plans are designed for routine and preventive care, not illness or injury. This distinction is the most common source of claim rejections, and it is worth understanding before diving into the specifics.
Routine care vs. illness care
The key factor in how a claim is evaluated is not the service itself, but the reason it was performed. The same service can be wellness eligible in one visit and not wellness eligible in another. When the purpose of a visit is unclear from the invoice alone, Wagmo may reach out to your veterinarian to confirm whether the visit was routine or illness-related.
For example: if your vet runs bloodwork as part of a routine annual checkup, that is typically reimbursable under your Wellness Plan. If your vet runs bloodwork to investigate symptoms like vomiting, lethargy, or itching, that visit is illness-related and falls outside of what Wellness Plans are designed to reimburse.
This applies to office visits too. A routine wellness exam is eligible. An office visit to evaluate or treat a health concern is not wellness eligible, even if the appointment looks similar on the invoice.
Wagmo Wellness is not an insurance product. If your pet needs care for an illness, injury, or emergency, that is what Wagmo's Insurance Plan is designed for. The two plans work together, but they cover different things.
Other common rejection reasons
If your claim was rejected for a reason other than the above, here are the other most frequent causes:
Invoice not itemized: Each service needs to be listed individually with its associated cost. A total-only invoice cannot be processed.
Invoice does not show proof of payment: Your invoice needs to confirm payment was made, not just show a balance due.
Wrong pet or no pet name listed: The invoice should show your pet's name, and the claim should be submitted under the correct pet in your Wagmo account.
Visit date outside your plan period: Visits that took place before your plan's effective date are not wellness eligible.
Utilization limit reached: Each plan tier has annual usage and dollar limits per category. If you have reached the limit for a service, additional claims for that service will not be reimbursed for the remainder of your plan year. You can check your remaining balances in your Wagmo account.
Item not wellness eligible: Some services and products are not included under any Wellness plan tier, including spay and neuter, microchipping, deworming, and specialist referral visits.