Animated Sketch Presentation

Every claim submitted will have an outcome, were going to talk about them all now!

Lemonade Presents

Claim Outomes

3. Fully Denied

2. Partially approved/partially denied

1.Fully Approved

This is an index

Reimbursed

applied to deductible

When opening a claim that was processed by a Claim Advocate it will bring you to the Workflow for the claim. At the bottom of the Workflow homepage if the claim is settled and closed you will see the claim outcome at the bottom (approved)Click on the each icon to the right to see a claim approved and paid and a claim approved and put towards the deductible in Blender

Blender Views

A fully approved claim means the pet's condition and everything claimed was eligible for coverage! However, a fully approved claim doesn't always mean the policyholder is getting a payout, remember only approved claims go towards the deductible and the policyholder will only be reimbursed AFTER they have met their deductible.

Fully Approved

The Blender view for partially approved claims will look just like approved claims on the Workflow home page and show how much was reimbursed or how much went to the deductible, but in order to see the breakdown of coverage you will need to dive deeper into the workflow Claim Determination section.

Blender

Partially approved or partially denied claim whatever way you want to view it will have some items, even If it is just one, that were not eligible. That could be because there were two conditions being treated at one vet visit, and one of the conditions is not eligible for whatever reason, or there were some items claimed that are direct policy exclusions.

Partially Approved/Partially Denied

A fully declined claim is just what it sounds like, every item on the claim was denied. This could be because the condiion claimed is not eligible due to being pre-existing or it could be a direct policy exclusion. These are the most common type of claim you will have conversations with policyholders about.Because denials are a frequent topic of conversations for policyholders we will talk about them more in the next sections of this course.

Fully Denied