Wagmo Insurance plan claims can be denied in full or in part for a number of reasons, most commonly issues with eligibility, incomplete documentation, or inconsistencies in the invoice.
After your claim is reviewed, you'll receive an email from our insurance team with a formal explanation of benefits. This document explains why the claim was denied and outlines any next steps available to you.
Some of the most common reasons a Wagmo Insurance plan claim is not approved:
- Invoice not itemized. The invoice shows only a total or lists services without individual prices. Each service should appear separately with its associated cost.
- No proof of payment. The invoice doesn't confirm that the services were paid for. Wagmo Insurance reimburses after the fact, so a balance-due invoice can't be processed. Submit a paid receipt or attach proof of payment to the claim.
- Pet name missing or mismatched. The invoice doesn't list your pet's name, or it lists a different pet than the one the claim was submitted under. If you have multiple pets, the invoice should clearly show which services were for which pet, and you'll need to submit a separate claim for each pet.
- Service date outside of coverage. The invoice is for a date when your pet wasn't enrolled in a Wagmo Insurance plan.
- Preventive or routine care. A Wagmo Insurance plan covers accident and illness services only. Routine preventive items, such as wellness exams, vaccines, or flea and tick prevention, are not eligible under a Wagmo Insurance plan. Those services may be reimbursable under a Wagmo Wellness plan if you have one.
If your Wagmo Insurance plan has a deductible, approved items are applied toward your deductible until it has been met. This is not a denial. Items applied to the deductible will appear on your explanation of benefits and contribute toward future reimbursements once the deductible is satisfied.