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How To Make A Pet Insurance Claim
By Susan Doktor MONEY RESEARCH COLLECTIVE
Pet insurance is like just about all other forms of insurance: you buy it hoping you never have to use it.
If you do need to file a claim on your pet policy, though, the process may be unfamiliar territory, especially if you’re a new policyholder. So we’ve created this guide to help you through the process with minimal fuss and confusion. Following our advice should help you to get the most out of your pet insurance coverage.
Table of contents
- How to file a claim against your pet insurance
- What do you need to make a pet insurance claim?
- How to appeal a pet insurance claim
- How much will you get back from a pet insurance claim?
- Pet insurance claim FAQs
- Summary of our guide to filing a pet insurance claim
How to file a claim against pet insurance
Each pet insurance company has its own system for filing claims. Most offer an online portal to file claims, check your claim’s status, pay your premiums and otherwise manage your account. Some companies also offer policyholders a mobile app.
Filing a claim online is usually fairly simple. Pet health insurance companies typically also give you the option of filing claims by mail, but that’s typically not the fastest route to reimbursement. It can take a few weeks up to a month for your claim to be processed.
How does pet insurance reimbursement work?
In most cases, when you need to file a pet insurance claim, you pay your bill at the vet office or clinic. You then file a claim to get reimbursed for the amount covered, which varies based on your policy details. A few companies will pay the veterinary office for your bill directly, but not all vet offices accept this form of payment.
Keep in mind that your entire vet bill won’t be covered; just a portion of it. Your reimbursement depends on your deductible, coverage limits and reimbursement percentage.
What do you need to make a pet insurance claim?
When you file a claim, you must submit supporting documents to your pet insurance provider. Generally speaking, the insurer will need the itemized invoice or receipt that your vet gives you after an exam or when treatment is complete. You may also need to complete a short claim form — usually online or in an app (although sometimes a mail-in form must be completed).
Most pet insurance companies require that you provide a copy of your pet’s medical records when you purchase a policy. If they didn’t ask for those then, they may do so when you submit your claim.
That way, the insurer can determine whether your pet’s treatment is related to a pre-existing condition. Nearly all pet insurance policies will deny claims for pre-existing conditions — which insurers usually define as any condition your pet has been treated for in the past 12 months — unless it’s curable and you happen to have pet insurance that covers pre-existing conditions.
Whether your pet insurance company pays or denies your claim also depends on whether your policy covers the service. Many exclusions apply. Routine preventative care won’t be covered unless you have a more comprehensive plan that includes wellness coverage. Routine care includes services rendered during an annual check-up, such as vaccinations.
How to appeal a pet insurance claim
If your claim is denied and you disagree with your pet insurer’s decision, you can file an appeal by contacting your pet insurance company’s customer care department. If your insurer refuses to pay a claim, it must explain why.
Pet insurance policyholders aren’t always as familiar as they should be with the details of their insurance coverage. Don’t be surprised, then, if the company points somewhere within the specific language of your policy to cite a reason why your claim was denied.
You may not have reached your annual deductible, for example. In addition, most pet insurance plans come with waiting periods. You won’t be reimbursed for any claim before the end of a waiting period, which is typically longer for illnesses (up to two weeks) than for accidents (usually a few days).
When is filing a complaint against a pet insurance company justified?
Filing a formal complaint against your insurer is different than appealing your claim. Usually, people file complaints with government agencies when they believe a company has deliberately acted unethically. Such a complaint may be subject to legal action.
If you feel your insurance company hasn’t followed he terms of your contract, and has rejected your appeal, it may be justified to file a formal complaint. Check with your state’s insurance department to see what your options are.
While its name may imply that it has significant authority in consumer affairs, the Better Business Bureau is not a government agency. Filing a complaint through the Better Business Bureau or other third-party review sites won’t result in legal action. Still, it will impact your insurer’s reputation and educate other consumers about your experience.
How much will you get back from a pet insurance claim?
The amount you are reimbursed for veterinary care will depend on the specifics of your policy. Most pet insurance policies are customizable. Insurers give you the option of selecting a specific annual deductible. They also allow you to choose how much of your bill they’re responsible for — percentages generally run from 70% to 90% of covered vet bills. Your policy will also have coverage limits.
Policies with higher coverage limits, lower annual deductibles, and a higher reimbursement rate cost more than plans with low coverage limits, high annual deductibles and lower reimbursement percentages.
Pet insurance costs depend on specifics about your pet (or pets if you have coverage for multiple pets) and your policy. A more expensive policy usually reimburses more money to you from each of your claims.
Pet insurance claim FAQs
Can you cancel pet insurance after a claim?
Most pet insurance plans allow you to pay for coverage monthly. After your policy's waiting period has ended, if you file a claim during a month you paid for coverage, your insurer should process your claim.
With most plans, you can cancel coverage at any time (with proper notice to your insurer), and there is usually no cancellation penalty. If you paid for your policy upfront, your insurer might refund you a pro-rated amount.
How long does it take to evaluate a pet insurance claim?
The best pet insurance companies will process your claim within a few days of submission, but it can take up to a few weeks. You may receive a notification when your claim has been received and is under review. How quickly you get paid is a different matter. It may take days, or it might take up to a month. Some insurance policies, like Trupanion, have a provision whereby they will pay your vet directly after approving a claim rather than reimbursing you for the cost of the vet bill.
How soon can you claim pet insurance?
How soon you can file a claim after purchasing pet insurance depends on the waiting period specified in your policy. Pet insurers impose waiting periods to ensure that customers can't file claims for pre-existing illnesses and accidents. Waiting periods may vary from policy to policy but are generally brief — just a few days for accident protection and a couple of weeks for illness coverage.
What are the most common complaints about pet insurance?
We surveyed several consumer review sites to find out what types of complaints against pet insurance companies are filed most often. Here are three common pieces of criticism pet owners have against pet insurance companies:
- Denial of claims based on a policy's pre-existing condition clause
- Slow reimbursement for claims
- Rising premiums over the years
Summary of our guide to filing a pet insurance claim
Filing a pet insurance claim is a pretty straightforward process that can be done online in most cases. Less clear, however, is whether and to what extent your claim will be eligible for reimbursement.
You can avoid surprise and disappointment with your coverage by being familiar with the following aspects of your policy:
- What does my pet insurance cover?
- Does my policy have a waiting period?
- Does my policy have an annual deductible, and how much is it?
- Has my pet ever been treated for the claimed condition before? (Pre-existing conditions are routinely excluded from coverage).
- What are my policy limits? Are the limits set annually or per condition?
- What percentage of my vet bills are covered and what copays am I responsible for?
Our advice? Read your policy carefully to have reasonable expectations of what’s covered and what isn’t. Whether or not pet insurance is worth it depends on the animal. Your vet bills won’t be 100% covered when you file a claim, and there are exclusions.
