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Frustrated: Pet Insurance Claim Denied

13K views 77 replies 37 participants last post by  ElkChaser 
#1 · (Edited)
UPDATE....Frustrated: Pet Insurance Claim Denied

I had my YLF Daisy bred in December. A week after we got her home from the breeding we noticed she had a bad smelling discharge. We took her to the veterinarian and she was diagnosed with an open pyometra. We chose to do an emergency spay and the final bill came to about $1,100.

I have Petplan insurance and filed a claim with them. They originally denied the claim because the veterinarian we saw when Daisy was a puppy wrote in Daisy’s chart at all her puppy appointments that she recommended having her spayed. Daisy didn’t have anything wrong with her physically, the vet just strongly believed in spaying all female dogs. We had the veterinarian write a letter to Petplan stating Daisy was healthy at the time and we appealed their claim.

Over 2 months later I get a letter in the mail today from them again denying my claim. They said they denied it because the vet did recommend having her spayed making this a preventable disease or illness which they will not pay for.

This doesn’t seem right to me. I bought pet insurance to cover large medical expenses and when I try to use it I get denied. It gives me the feeling that no matter what type of claim I have they are going to weasel out of it. Also, is it normal for a veterinarian to note several times in a dog’s chart to have a healthy puppy spayed? Thanks for letting me vent.
 
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#2 ·
Similar thing happen to me. I now drive over an hour to the vets because the local one won't even let you in the door unless they are fixed.

They claim it's because of the grants or some funding they get requires it.:rolleyes:
 
G
#3 ·
That is a total and complete crock. There's got to be a way around it and your vet should be willing to help you. Your vet should write a letter specifically stating that they did NOT tell you spay her to prevent pyometra. They told you to spay her to prevent unwanted pregnancy -- and maybe they might throw in mammary cancer, but that might screw you for later if your policy covers it. This is really unfair.

That would be like if your vet recommended that you put your dog in a box and never let it out so it doesn't get hurt or sick... geesh. It's common sense.

Your vet should have never written that on their records OR they should have written that you were keeping her intact for future breeding...

How much was the claim for?
 
#12 ·
Here is the part of the policy they are using to deny the claim.

aa.The cost of any treatment a veterinarian normally
recommends to prevent an injury or illness, and any
costs that arise from an injury or illness with respect to
which you were advised by a veterinarian to take
preventive measures and did not do so.
 
#6 ·
Look at your appeal process in your policy. Some have 2 appeals and an arbitration (or outside vet) to look at the claim. Some give the opportunity to file a complaint thru your state department of insurance. Make sure all of this is done in writing and certified mail.

I notice Petplans website says you are bound by the state of Idaho and waive jurisdictional, venue and service of process.

Ther is also a website that reviews all pet ins plans. You can write a review of Petplan and what they did on your claim.
 
#9 ·
What a crock.
My wife's and insurance agent and I go to the dog house everytime I say this (even though she agrees with me)but here goes...INSURANCE COMPANIES are a joke. My wife knows I'm telling the truth and witnesses it all the time...and the dang agent is the one who ends up getting the bad rap.

Unless there's an attorney from this forum, in other words like minded like us, you'll most likey get taken again if you try that route.

I've had nothing but bad luck with insurance companies and attornerys.

I had a dog with the same issue, a 4 month old pup. Five hundred for the pup ($500), then found out had the same issue as your dog...$1500 dollars after the surgery we got one more week with her...and I'm out $2000 bucks. Yeah, we got a replacement but that's all that was offered and it didn't seem as if asking for a refund of vet bill's was going to happen...so, I was stuck with accepting the dog who ended up with severe hip dyslpasia.

Good luck my friend...good luck.
 
G
#11 ·
I think that the Vet 's notation on the records is the root of the problem that he/she should have to eat the cost of the surgery. The Vet needs to learn a lesson too.
That's a good point... See if credit your account (versus give you $$$)

I'm all about 99% of people spaying and neutering their dogs. But the other 1% shouldn't be penalized for the stupidity and neglect of the other 99%....
 
G
#15 ·
If you cut her back leg off, she'll never have a broken back leg. If you cut her ear off and out, she'll never have ear infections. If you skin her, she'll never have a staph infection... I mean, c'mon. That's frustrating.

I have personally had almost all great experiences with my insurance companies. I'm sure, like most insurance companies, these pet ones are going to say no and then fight at least for a bit before they'll pay a claim... like healthcare... or auto...

-K
 
#17 · (Edited)
I am surprised that they are taking this approach with you. Looking at the exclusions in my policy (yes it is a Petplan policy) it says:

V. General Exclusions
The following general exclusions apply to your policy and coverage parts. We will NOT pay costs you incur for your pet in the following categories:

j. Costs arising out of or related to:
(1) Breeding.
(2) Pregnancy.
(3) Whelping or nursing.
Except costs of any complications arising from these procedures.


It seems that what you have is a complication, a condition that their policy claims is covered.

Funny that also listed under exclusions is:

u. Elective or specialty procedures which are not deemed medically necessary, including but not limited to:

(1) Docking of tails.
(2) Removal of dewclaws.
(3) Removal of eyelashes.
(4) Cropping of ears.
(5) Spaying or neutering.
(6) Cosmetic dentistry.

So it is elective surgery unless a vet says it is medically necessary!

This is what they are going on:

7. CARE FOR YOUR PET

a. In order for your policy to remain valid you must take care of
your pet and arrange and pay for your pet to have the following:

(1) An annual health check.
(2) An annual dental exam.
(3) Any treatment normally suggested by a primary vet to
prevent illness or injury.


b. If your pet has not been examined by a primary vet within the
twelve (12) months prior to the effective date of the policy you must arrange to have your pet examined at your own expense within the first 30 days after the effective date of the policy. The examination will be used as the basis for determining any pre- existing conditions.

c. To be afforded coverage for the diseases listed below, you must keep your pet vaccinated at your expense, as recommended by your primary vet. We will not pay any claims that result from or are related to any illness that is listed below that a vet- recommended vaccine would have prevented.

(1) Canine distemper.
(2) Canine adenovirus 2 (canine viral hepatitis).
(3) Canine parainfluenza.
(4) Canine parvovirus.
(5) Leptospirosis.
(6) Rabies.

d. You must take your pet to be examined and treated by a primary vet as soon as possible and within forty eight (48) hours after your pet first shows clinical sign(s) or symptoms of an injury or illness.


They seem to be taking the position that your policy has been invalidated because you failed to provide treatment normally suggested by a vet to prevent illness or injury, yet they say that they will cover complications from breeding. No contradiction there!
 
#21 ·
Why don't you all just put the money you pay on insurance in your own medical savings plan for the dog? It's your money then and you get to use it like you want to. Easy peasy....
 
#23 ·
I understand what you are saying but the policy only costs about $300 per year. The whole purpose of the insurance was to cover expensive medical emergencies so I wouldn't have to make a decision for my dogs life based on finances. This whole experience hasn't given me much confidence in the system.
 
#24 ·
I feel for you, I am sorry that they are being such a pain, hope they realize what they are doing is wrong, and cough up the money. Sad part is an insurance company never admits their wrong.
 
#25 ·
Am I the only one that refuses to allow the insurance companies to get richer off of our dollars. I made up my mind a while ago that instead of giving an insurance company $25 a month per dog I would give it to myself. I decided to self insure so I opened a savings account and now have a monthly draw for each of my dogs....and the nice thing about it is I can decide if I want to deny my own claim or not. I understand that it is a gamble for a year or two until your account gains some ground.

The one thing I learned many years ago was that the purchase price of a dog is the cheap part. If you add up food, vet bills and training gear the original price of the dog seems like peanuts.

By the way that is wrong what they are doing to you. And if the insurance company doesn't pick up the bill the vet should be liable for some of it.
 
#35 ·
And if the insurance company doesn't pick up the bill the vet should be liable for some of it.
I would like to understand the logic that led to that conclusion. The veterinarian provided professional services how the bill is paid is the responsibility of the owner.
 
#27 ·
Won't work if the op signed an estimate approving the surgery. Had that tried on me once. Not my fault that the insurance company wouldn't pay.

I hate insurance companies for humans as well as pets.
 
#28 ·
What wheelhorse and wvlabman said.

A policy that "only" costs $300 per annum and then doesn't pay out isn't IMO cheap; it's very expensive.

I put a rough equivalent of $70 aside each month in a small deposit account (this for three dogs) to cover vet bills including shots, Frontline, worming pills and all that stuff. If I need to spend a lump sum on something serious, I have the money saved in the account to do it. If it isn't required I've still got it.

Most policies have an excess of $55 before paying out on any treatment which by amazing coincidence is about the average charge for an examination and a dose of drugs. Very few policies will pay out for chronic conditions like HD; they'll pay for the exam (minus $55) X rays and what have you, but not for any serious post treatment, generally using a wriggle out like the one you have been sold. They won't pay for continued prophylactic treatment either. Some won't offer cover for working dogs.

All in all I regard dog insurance as one of the poorer investments we can make, so like the other guys, I avoid it and make other arrangements.

Regards

Eug
 
#29 ·
As Susan said "Been there, done that" with PetPlan.

That is exactly why several years ago when we looked at what we were paying a month for two dogs and how our deductible kept increasing (with minimal claims) as did the monthly payments, we decided to cancel with PetPlan and take the same money and put it into a "dog health bank account".

Due to the fact that fortunately we had no major issues for a period of time, and yes you are putting yourself at risk until you can build a bit of a cushion, we know we will never have a claim refused!
 
#31 ·
Takes a long time to save up enough to cover an injury that costs greater than $10,000 to repair and rehab.
 
#32 ·
How did the insurance company get ahold of her charts in the first place? I agree with the majority on here that the vet went over the top in putting multiple times that she should be spayed as if there was a problem from the start.
 
#43 ·
How did the insurance company get ahold of her charts in the first place?
Pet Plan requires you send the records for the bill you are seeking reimbursement for............ some policies do not, unless they have a question, such as VPI.
 
#33 · (Edited)
I looked into insurance extensively, and ended up with Embrace on the recommendation of several other golden retriever owners.
I HAVE NEVER HAD TO FILE A CLAIM so I don't know how it will be.
That said, the policy I took out on my youngest boy is what I consider "catastrophic only". I opted for a $1000 per year deductible. PetPlan, and most others, have a PER EVENT deductible, whereas Embrace has a per year deductible. After that, they will pay 80% of all vet bills up to $15,000 per year, the amount I selected. They will pay acupuncture and/or chiropractic, too.
It costs me $12 per month. To me that's a small cost to pay in case my boy gets cancer, as 65% of all goldens do, or breaks a leg, etc.
Yes, they have exculsions and caveats like all insurance, but I felt theirs was the best for my situation They have a 6 month orthopedic waiting period, unless you get a certification from your vet that the dog has been examined and found free of orthopedic issues. This is a brief office exam by a regular vet.
They also will review your medical records, which you submit, and tell you whether or not anything will be considered pre-existing.
Now hopefully I will never have to find out how well they pay on claims.
 
#37 ·
Yeah, I'd try to stay on the good side of the vet while you try and get this taken care of. I would certainly talk to her/him and suggest strongly that they add a note of something like "as part of my normal consultation, I recommended spay/neuter" also stating something about that not being due to a health issue but as a normal suggestion to all patients owners.
That could at least protect future owners from a situation like this.
 
#44 ·
I just got done speaking with a manager at Pet Plan about by my claim denial. He said that claim denial came down to the veterinarian’s recommendation in Daisy’s chart to spay her when she was a puppy. He said if the veterinarian hadn’t wrote that she recommended spaying Daisy in her chart they would have paid the claim. He said regardless that Daisy was healthy at the time or that the recommendation was based upon the veterinarian’s opinion that all female dogs should be spayed; it was still a recommended treatment that we didn’t follow.

I feel that I need to contact my veterinarian and discuss this with her. I don’t know if it is standard procedure to recommend spaying and to note it in the chart, but you can see it was detrimental to my insurance coverage.

The fellow I talked to did suggest that I request underwriting on my policy. He said this will tell me exactly based upon Daisy’s medical history what they will not cover or what they determine as preexisting. I would suggest anyone with a policy do this.
 
#49 ·
I just got done speaking with a manager at Pet Plan about by my claim denial. He said that claim denial came down to the veterinarian’s recommendation in Daisy’s chart to spay her when she was a puppy. He said if the veterinarian hadn’t wrote that she recommended spaying Daisy in her chart they would have paid the claim. He said regardless that Daisy was healthy at the time or that the recommendation was based upon the veterinarian’s opinion that all female dogs should be spayed; it was still a recommended treatment that we didn’t follow.

I feel that I need to contact my veterinarian and discuss this with her. I don’t know if it is standard procedure to recommend spaying and to note it in the chart, but you can see it was detrimental to my insurance coverage.

The fellow I talked to did suggest that I request underwriting on my policy. He said this will tell me exactly based upon Daisy’s medical history what they will not cover or what they determine as preexisting. I would suggest anyone with a policy do this.

So if your vet had suggested shooting little Daisy, and you didn't, does that mean no further coverage would be available? Because you know, if Daisy were dead, she certainly couldn't get sick and incur medical expenses. :confused:
 
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