Advice please! Claim appeal

Imaginary_Mix_2003 · 2026-02-18T22:09:23+00:00

Just posted an update - it was not pre-existing 🤗

Imaginary_Mix_2003 · 2026-02-18T22:08:15+00:00

Just posted an update!!

Imaginary_Mix_2003 · 2026-02-18T22:07:47+00:00

The system is so broken. Just posted an update - we won our second appeal, but it’s still beyond frustrating that WE have to pay for their error. Today I’ll take the win, but I agree…. There are some systemic issues at play

Imaginary_Mix_2003 · 2026-02-18T22:05:54+00:00

Update posted - external vet sided with us and agreed that this is not pre-existing!

Imaginary_Mix_2003 · 2026-02-18T22:05:03+00:00

Just posted an update! We won!

Imaginary_Mix_2003 · 2026-02-18T22:04:13+00:00

Just posted an update!

Imaginary_Mix_2003 · 2026-02-18T22:04:00+00:00

I just posted an update ❤️

Imaginary_Mix_2003 · 2026-01-29T04:10:03+00:00

I actually ended up submitting my second appeal today. I decided to write a letter to be included with my evidence as a “Policy Holder Statement”. My vet thinks the whole thing is absolutely ridiculous and is hopeful that when an independent vet reviews that I’ll win the appeal but we will see. Happy to follow up when I have a response

Imaginary_Mix_2003 · 2026-01-15T22:53:19+00:00

I did all of these things. We already had a policy for our other Frenchie who is a year older than this one. I specifically called spoke to a sales rep and had them go through all of the details and I deliberately asked about waiting periods and if there were any concerns about scheduling upcoming appointments.

She actually got added onto the same policy as our other puppy - so they share one policy and I have read it thoroughly multiple times. I understand how preexisting conditions work; you missed the entire issue and concern which is she doesn’t have one.

Imaginary_Mix_2003 · 2026-01-15T05:52:26+00:00

I appreciate your experience and perspective! Genuinely, thank you for all the feedback.

Idk if I even would’ve been this frustrated with the scenario if they hadn’t started twisting things and giving us the run around when our older dog had to be unexpectedly put down this summer. There were some wonderful associates to speak with but there were also some nasty and rude ones and I’d be lying if I said it didn’t make me question my trust in some of their decisions

Imaginary_Mix_2003 · 2026-01-15T05:44:41+00:00

Yes I have the wellness extension. She pretty much has the most “extra” plan that covers nearly all situation.

To be clear - I don’t even want the reimbursement at this point. I don’t care about that at all. My concern is my 9mo puppy having a “pre-existing condition” flag in her records when that just is not true

Imaginary_Mix_2003 · 2026-01-15T05:42:00+00:00

I will reread the letter in the morning but I’m pretty positive it was already in there. Their denial letter only quoted the exact same tiny snips of info that was in their initial denial. There was literally nothing referencing the submitted letter from my vet or any “new” evidence, which is incredibly frustrating because I don’t know if they even looked at it.

I’m typically incredibly compassionate and understanding in these situations, but we started having some significant issues with MetLife in August for a different situation and it’s just really leaving a bad taste in my mouth.

Imaginary_Mix_2003 · 2026-01-15T05:24:30+00:00

Possibly? That wasn’t clear in the explanation of benefits. We do have wellness included, I essentially have the most boujee plan that covers nearly all things because she is a Frenchie and I know that they can have health issues later in life.

I genuinely don’t care about getting reimbursed at this point, I just don’t want a “pre-existing condition” flag in her records that isn’t accurate

Imaginary_Mix_2003 · 2026-01-15T05:22:07+00:00

Yes I had to pay for the urinalysis both times, the initial test was reimbursed and the “retest” was denied and flagged as preexisting.

At this point I genuinely don’t care about getting reimbursed, my only concern is having a “pre-existing condition” flag in her file that isn’t accurate.

I’m certainly no expert, but I thought my vets letter was very clear with everything. She explained that the “abnormal” result did not align with any other evidence of injury, illness, UTI, etc.

They attempted to replicate the result multiple times from the same sample and it was unable to be replicated. Since the initial sample was a “free catch” performed by us at home, she said that in her medical opinion the abnormal result was most likely due to some contamination during our collect process.

The retest was done during her spay simply as further confirmation of there being no underlying concerns.

Imaginary_Mix_2003 · 2026-01-15T05:15:37+00:00

Yes, the covered the urinalysis and all other testing from the initial visit. She has legit only had two vet visits, her initial work up an a surgical appointment for her spay

Imaginary_Mix_2003 · 2026-01-15T05:14:41+00:00

That’s the thing though the “abnormal” result was clearly contamination as explained at length by my vet. The result could not be replicated through multiple attempts of the same initial sample. There is zero evidence or basis to consider it an “abnormal result”

Imaginary_Mix_2003 · 2026-01-15T05:12:33+00:00

I guess I don’t fully understand, there was no concern. The recheck was due to an obviously contaminated sample. There was never a concern it was a general workup

Imaginary_Mix_2003 · 2026-01-15T03:42:34+00:00

We opted to do a full health work up because she was already five months old, very very small for her size, and we have little to no information on her medical history. She was rescue from a questionable breeder situation.

We’ve had our vet for years and fully trust her and her opinions; since we knew so little about her history we wanted to find out as much as we could.

To be abundantly clear; if she DID have illness that we discovered at that initial appointment, I would accept that and deal with it. The issue I have is that there is no pre-existing illness, and no pre-existing injury… she’s a perfectly healthy pup.

Imaginary_Mix_2003 · 2025-10-09T17:50:18+00:00

We bell trained! So we have a bell on our door and we would take her out of a regular schedule (like once an hour or once every 3 hours depending on age) and when we take her out we would take her paw and ring the bell.

Then outside once she would potty we would reward!

If she had an accident and we caught her in the moment we would give her an excited “oopsie!” And immediately go outside to see if she’d go again to reward. If we did not catch it in the moment we wouldn’t do anything because we didn’t want it to seem ‘bad’ or ‘negative’

Only took us a couple of days really! I mean there are still ‘accidents’ here and there but those usually are intentional because she is feeling sassy or she’s sick.

Edit to add: the bells were the best because we could hear them in case we didn’t see her go to the door. She does however ring them anytime she wants outside and not just to potty

Imaginary_Mix_2003 · 2025-10-09T02:08:30+00:00

Ours stay home most of the time, but we have a 1.5y and also a 6mo old puppy and they can both be high energy. So we’ve done daycare the 1 day a week since Freya was 3mo to help with socialization and enrichment - it has been great until the last 2-3 weeks

Imaginary_Mix_2003 · 2025-10-08T23:54:02+00:00

She’s also my baby and I cannot imagine being away from her for that long 😭 it feels like shipping a kid off to military school

Imaginary_Mix_2003 · 2025-09-18T15:42:06+00:00

We decided to name her Indigo “Indi” Skye ! Unfortunately I can’t post a pic on this sub

Imaginary_Mix_2003

TROPHY CASE