Pet plan--ccl injury restrictions

[Rainmaker]

For what it's worth, here in Canada, I phoned several pet insurance companies about 1 year ago and was told that if there had been an acl tear in one leg then the other leg would be excluded from coverage.

Which is why many go with Petplan, because they will, alot don't. I went over lots and lots of insurance companies for my dogs, Petplan offered the most coverage for what I wanted, for the least $$. No insurance is perfect or will cover everything, but I've been happy with Petplan. Takes the edge off the major stuff.

[claimsadj]

You've yet to comprehend the question I am asking. Does surgery on a non injured knee prevent that knee from future coverage? Forget everything else, that's the only question I'm trying to get answered.

You are not making any sense. The insurance covers injury.

You buy insurance. Knee 1 has a partial tear before you buy insurance, or that develops during waiting period. Insurance does not pay for knee 1 because the injury is a pre-existing injury.

Knee 2 is ok at moment. If you decide to fix knee 2 at the same time as knee 1, for reasons of economy and expediency, insurance will not pay for either. It will not pay for knee 1 because it is a pre-existing injury. It will not pay for knee 2 because there is no injury.

If knee 2 develops a partial tear during the waiting period - whatever it is - you are out of luck.
If knee 2 develops a partial tear after the waiting period - whatever it is - you are covered at your insured rate - whatever that is.

As I mentioned, I have a dog, which developed a problem with knee A prior to Pet Plan insurance. I paid as it was a pre-existing injury. It developed issues with knee B after waiting period (I believe it was 6 months at the time, but it could have been 12). Pet Plan paid at 80% rate with $200 deductible, which is my plan. Problems developed one year later with knee B, and surgery needed to be done again. Pet Plan paid at 80% rate with $200 deductible.

To avoid future insurability issues, I ensure my puppies when I purchase them so that the waiting period becomes a non-issue.

I think I have written all I care to on the issues of ACL and insurance at this time.

However, Pet Plan has been very good to me.

[Ted Shih]

I've had Petplan for years on multiple dogs. Though I haven't had to use it for CCL repair (thankfully), I do put mine on as puppies. If I had an older one, I'd do the exam to avoid the waiting period. The policy documents can be accessed online through one's account. This is what mine says about cruciate injury, under exclusions:

Any treatment associated with damage or rupture of cruciate
ligaments, or defects of the patella during the first six (6) months
that the policy is in effect. Except coverage is provided if a
certificate of health is obtained stating that your pet has been
examined during the first 30 days (beginning on the effective
date of the policy) and stating that there are not any preexisting
conditions relating to the pet’s cruciates or patellas.

Here is what Pet Plan wrote me in November 2010

Just a reminder to ask your Vet to write a specific notation in your pet’s written medical notes during the first 30 days, beginning on the effective date of the policy, stating that
“your pet has been examined and there is no evidence of cruciate or patella disease”.

Otherwise there will be a 6-month waiting period for Luxating Patella and Cruciate
Tears.

Two-three days after I get a puppy, I get her examined and make sure that the vet looks at her knees and writes in the notes “your pet has been examined and there is no evidence of cruciate or patella disease”.

[Ted Shih]

You've yet to comprehend the question I am asking. Does surgery on a non injured knee prevent that knee from future coverage? Forget everything else, that's the only question I'm trying to get answered.

Read what I wrote again.

[Ted Shih]

As I mentioned, I have a dog, which developed a problem with knee A prior to Pet Plan insurance. I paid as it was a pre-existing injury. It developed issues with knee B after waiting period (I believe it was 6 months at the time, but it could have been 12). Pet Plan paid at 80% rate with $200 deductible, which is my plan. Problems developed one year later with knee B, and surgery needed to be done again. Pet Plan paid at 80% rate with $200 deductible.

Here is what I wrote you previously
Why don't you ask Pet Plan what their policy is?
Now, I really am out of here.

Ted

[Rainmaker]

Here is what Pet Plan wrote me in November 2010



Two-three days after I get a puppy, I get her examined and make sure that the vet looks at her knees and writes in the notes “your pet has been examined and there is no evidence of cruciate or patella disease”.

Yes, thank you. Good reminder.

[claimsadj]

Forget it Ted, you aren't understanding the question. Per pet plan if you have the good knee operated oniut of pocket for the reasons mentioned previously that knee will never have any coverage for future injury. That's what I was asking the whole time. Does that make sense Ted?

[Russ]

Claimsadj,

I assume you are a claims adjuster from your name. Get a copy of the policy and read it. They are bound by the contract. Since it is a contract of adhesion, any ambiguity goes in favor of the policy holder. To cover or not to cover is not an underwriting decision unless they are giving more coverage than the policy specifies.

Russ

[claimsadj]

They don't send out policy booklets that im aware of. I stating what I was told by pet plan. Everything is not spelled out in a policy, lots of the language is left open ended for a reason.

[terrax]

Unfortunately Petplan is not yet available in my part of Canada, hopefully by the end of the year. At that time I will check in to it as non of the companies here will cover the good knee after an injury to the other one.