There are a variety of reasons why all or a portion of an insurance claim might be rejected, such as issues with eligibility, incomplete documentation, or inconsistencies in the information provided.
After your claim is reviewed, you will receive an email from our insurance team with a formal explanation of benefits. This letter will provide a detailed explanation of why the claim was rejected and any further steps you may need to take.
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 preventative care: Wagmo Insurance only covers accident/illness services, so if the services on the invoice are for routine, preventative care it will not be covered by your Insurance plan.
- Applied to deductible: While not actually a rejection, if your plan has a deductible, approved items will be applied to your deductible rather than reimbursed directly until your deductible has been met (which can be confusing).