Mo has been a wonderful commenter on my pet insurance series, and she not only has many years of experience filing claims and getting the most out of her insurance, she’s used several different insurances, so she’s a great source of information for how to deal with the insurance. She agreed to write up a how-to guide on filing claims, so without further ado here is Mo’s Guide:
Complaints about dissatisfaction with pet insurance abound wherever pet insurance is discussed on the internet. There are two major categories affecting the experience of pet insurance policyholders: The overwhelming number of complaints indicates we’re don’t think we’re getting what we’re paying for, and/or we don’t feel we’re getting what we were promised. In a moment we’ll look at ways to get the most of the insurance we’re paying for. First, we’ll look at some “promises” that are implied.
We’re given a certain impression of what we’re buying when we buy a pet insurance policy. We seem to forget it’s strictly “insurance” like any other – insurance is dry and stuffed with rules and legalese…it’s a business. In the pet insurance world we’re spoon-fed a big steaming pile of…snuggly, warm kitty and puppy kisses lavished upon us by very happy and healthy pets – they just want to play, look adorable, and snuggle, they’re just so darned happy!! That pet insurance must provide our pets all this good health and happiness!! Their websites and brochures give the impression they love & care about our pets too (who could not?), and they’re so generous and caring they’re going to help pay our vet bills!!
The implied promises here are propaganda just like any advertising. The difference here is that it targets deep within our hearts…our love for our companions. We can make the mistake of trusting these companies to care about us, our pets, and our bank accounts, and we will find ourselves seriously disappointed, feeling ripped off, and feeling betrayed…. I don’t believe I’m “in good hands with Allstate” or that “State Farm is there for me like a good neighbor”. It’s important to think beyond the advertisements.
As for getting what we’re paying for, pet insurance does actually help significantly with vet bills but you need to be realistic, and you need to be responsible for making that happen. It requires a little bit of work. Don’t negate the propaganda, just be sure to remember you are dealing with the business of insurance.
We begin by doing everything we can to stop potential problems before they start. What I suggest here may seem like a pain, but it really takes just a few minutes here and there and it can save you a lot of time, trouble, anguish, and disappointment (and quite a bit of money)…things you want to avoid when you’re in the midst of the emotional turmoil you will find yourself in if your companion animal gets very sick or injured. You definitely don’t want to do battle with your pet insurance when you’re emotionally enmeshed in caring for your sick or injured companion.
- The first and foremost rule is, pet insurance does not cover pre-existing conditions. Period. They will do everything they can to determine whether a condition was pre-existing, so if it was, don’t get your hopes up that they won’t figure it out…they will.
- Plan ahead (specifics are described below). Understand that all insurance companies retain a lot of money when they are not paying it out on claims. Don’t expect them to automatically find every possible way to pay out money on your claim.
- When you adopt or purchase your pet, get a copy of all available records from the shelter, previous vets, etc. You want as complete a history as you can reasonably get. This is not just for insurance purposes, but it could be very important if your pet becomes ill…it will give your vet some history to work with.
- Every time you submit a claim, include:
- Invoice showing exams, treatments, labs/diagnostics, medications, etc. – all charges and payments made (they require this).
- Copies of all lab/diagnostic results related to that claim – bloodwork, urinalysis, biopsy/histopathology reports, etc.
- Your vet should readily provide you with these upon request. I make it a habit to get copies when the diagnostics are done so I have them if needed. I usually bring a SASE or two with me on each visit for illness or injury for the clinic to send me copies when they get the results – the easier you make it for the clinic, the better for everyone. Sometimes results come back at different times and staff may not know that, hence sometimes-more-than-one SASE is needed in case they send you some results but then more arrive at the clinic later.
- To elaborate, the lab/biopsy/histopathology reports not only back up the primary diagnosis, but could also show concurrent problems. Depending on your insurance type, some will consider each problem revealed by these reports in addition to the primary diagnosis, and may pay benefits for each. Some of the claim forms ask for specifics on all treatments; some ask for only a diagnosis – that’s insufficient to describe what’s going on with your pet, so the diagnostic reports can be important.
- If you really want to cover all the bases, you could also get copies of the vet’s chart notes and include those. I usually don’t do that unless it’s the first claim I’m filing, but it doesn’t hurt. (This typically amounts to only 3-4 pages total submitted for a claim, including the claim form and invoice…it’s not a lot.)
- If this is your first claim with the insurance company (especially if you’ve had the insurance for less than a year), along with the above you should also include:
- Vet records for the past year.
- Vet records means chart notes and copies of all lab/diagnostic results, including same from any specialists. This is so the insurance company has a history of your pet’s health prior to the claim so they can determine if the claim is related to a pre-existing condition. If you don’t send this information your claim will be delayed, perhaps for up to a couple of months. They will put it on “hold” and request the records from you and/or your vet before they’ll process your claim, so you’ll greatly speed things up if you send the records up-front.
- If you’ve had the pet for less than a year, include those records from the shelter and/or previous vets mentioned earlier, including adoption/purchase documentation showing when the pet came into your family.
- Particularly for initial claims for a pet, I include a cover letter explaining anything I think might help the insurance company understand the history of my pet, such as, I tell them I just adopted my cat six months ago, enclosed are the records from the shelter and documents showing date of adoption, etc. If I don’t have any other vet records I explicitly state that, and explain why (just adopted, only have initial vet introductory visit chart notes (include those), cat has been healthy up until now, etc.) If you don’t include all of the information, they will delay processing your claim until they get around to requesting the vet records, and either receive them or confirm none exist. Some companies will flat out deny the claim, not troubling themselves to request vet records, and you have to essentially start over by appealing the denial (which is incredibly frustrating), so it’s best to provide them with all the info up-front.
- And finally, know what level of coverage you’ve purchased. You will only receive benefits according to the coverage you purchased. If you purchased a lower tier you should have a realistic idea of what to expect in benefits (i.e., if you spend $8,000 you may still only get $200), so consider that carefully when buying coverage.
To summarize: This all sounds like a lot to do, but it’s actually straightforward and simple. Just plan ahead – get a copy of records when you adopt/purchase, get copies for each vet visit. Send copies with your claim. Include an explanation letter if necessary, especially when filing your first claim for an illness. The insurance company will insist on knowing the history of your pet’s health before it will process a claim for an illness. Pre-existing and directly related conditions are not covered by pet insurance.
A big thanks to Mo for taking the time to provide such a clear and comprehensive guide to help us file our claims! As big a job as it is to research the pet insurance that best fits our needs, it is only the first step, after all. Thanks Mo!