The Figo Guide to Claims
November 30, 2021
So you have pet insurance - but what are claims? How do you file one, how do you know you'll get reimbursed, and what are the different types of claims you can file? We cover all your burning questions in the Figo Guide to Claims
When it comes to traditional Pet Insurance, claims are anything but clear and simple. Cue the claims experts at Figo! We're here to make life easier for pet parents and answer any questions you might have in our Ultimate Guide to Pet Insurance Claims. To start, did you know that there are two different types of claims you can file with Figo?! How exciting, right? These two claims are wellness and standard accident, illness, or injury. When filing your claim, it is important that you understand the difference between the two, as well as all the other aspects of the process. Let's take a look at some of the most frequently asked claims questions we get at Figo. Ready?
What are claims?
At Figo, a claim is something you submit when your pet has a medical expense. You submit your claim and Figo pays the expenses that fall under your coverage based on your chosen reimbursement percentage, minus the deductible. If your deductible has been met, Figo reimburses you based solely on your chosen percentage!
What is a wellness claim?
A wellness claim covers all that good preventative care your pet needs. Think vaccinations, dental, spay/neuter, microchipping, and other routine vet visits that keep your dog or cat happy and healthy. Typically, wellness claims are processed in a few business days - faster than your typical accident/illness claim. This is because we do not have to investigate past vet records to process them. It’s important to note that your pet’s wellness claims will only be covered if you purchased wellness coverage with your Figo plan. If you don’t carry wellness coverage for your pet, your plan still covers accidents, illnesses, and injuries, so long as they are not pre-existing to your policy.
What is a standard accident, illness, or injury claim?
A standard accident, illness, or injury plan includes a wide array of issues your pet may have. For more information on the specifics of these claims as they pertain to you, you can always consult your policy, contact the customer service team via chat, text, email, or over the phone. Additionally, you can visit our website to see a general list of what is and is not covered. On average, your first claim can take 7-14 business days to be processed if you have not already provided your pet’s previous two years of medical records. That’s why it is a great idea to be proactive and upload those records to your Pet Cloud as soon as you purchase your Figo policy. It can save you time and energy later.
How do I file a claim?
This might sound basic, but the first and most important thing to know when it comes to claims is how to file one. If you’re a member of the Figo Fam, the first step is to log into your Figo Pet Cloud. Next, you will select the “claims” icon and answer the questions that come up. You will then upload a copy of your paid invoice, showing a $0 balance. Then, click submit and you’re done! If you have not already uploaded medical records for your pet to your Pet Cloud you will need to contact your veterinarian and have your pet’s medical records sent to firstname.lastname@example.org.
What does processing my first claim look like?
Your first claim takes a bit longer as we need to request the pet's full medical history and complete a review of it in order to create a "Prior Medical History." Depending on how old the pet is, we usually require medical records from two years prior to the start of the policy to the present date. This would include any adoption or breeder records. The good news is that after your first claim we only require the date of service medical records to be reviewed. As a result, your claim will be processed much faster after the first claim.
How do I track my claim status?
You can track the status of your claim via the Pet Cloud. Once your claim is closed, an explanation of benefits is uploaded to your Pet Cloud. This can be confusing to read for the very first time, which is why we have provided our clients with this sample EOB. Familiarizing yourself with the sample explanation of benefits is a good idea so that you are a pro by the time you receive yours for the first time!
Am I guaranteed to be reimbursed for my claims?
While in an ideal world, claims would be fully covered every time, Figo cannot guarantee coverage for all claims. Why? Well, to start, coverage is based on your veterinarian’s notes and medical records provided for the date of service. Then, a licensed claims adjuster will review your records and your pet's medical history to make sure that the claim is eligible for coverage under your policy. That may sound frustrating, but wait, there’s a bright side. At Figo, we can conduct a pre-approval for your claim! This can help prevent any surprises down the road. To request a pre-approval, you will need to email email@example.com with an itemized estimate for the procedure/treatment and your pet’s full medical history. Timing-wise, this can take between 7-10 business days to process. Also, note that pre-approval does not always guarantee coverage, as Figo will still need to review the claim once it has been submitted. Phew – still with us?
Is a claim worth submitting if it’s less than my deductible?
At Figo, we get this question often. Let’s set the record straight – this is not the case! All covered treatments will contribute to you meeting your deductible, so be sure to file any claim you have. There are no penalties for filing claims on your pet’s policy, and claims at Figo will never affect your pet’s premium.
What happens if I don’t agree with my claim resolution?
Great question! If you don’t agree with the decision of your pet’s claim after reviewing your explanation of benefits, you still have options. You can always file an appeal for a closed claim. To do this, simply email firstname.lastname@example.org with an explanation of why you or your vet disagree with the final decision, as well as all supporting documentation. Once your appeal has been received by our Claims Department, you will receive an email confirmation. Note: Appeals may take up to 30 days to be reviewed.
If any of this still isn’t clear to you, our customer service team is full of pet insurance experts! Call them at (844) 738-3446 or email them at email@example.com and they will answer any question you have about claims or your policy!
Kirsti Randazzo is a Marketing Coordinator at Figo, along with being a licensed insurance professional. In her spare time, she enjoys hiking with her dog, reading, writing, and traveling.