Your Pet Insurance Guide

Interesting Stat on Pet Insurance Reimbursements

I just finished reading the March issue of Veterinary Forum Magazine. Tucked in the corner of page 24 was an interesting statistic. Pets Best Insurance reviewed its reimbursements over $500 and found that:

• 54% are for regular veterinary care
• 35% are for specialist care
• 11% are for emergency clinic care

What this means is that almost half of significant veterinary bills occurs outside your regular veterinarian's office. Many clients don't even think about having to visit anyone but their regular veterinarian, but odds are at some point you will have to take your pet to an after-hours emergency hospital. Since the best techniques for handling some problems require greater expertise or more advanced technology than your regular veterinarian may have, at some point you will also likely be referred to a specialist. For example, some invasive tumors are best managed by having a CT scan or MRI done in order to plan the surgical procedure and insure that all the tumor is removed. Some complex medical problems are best handled by internist who see and manage these problems much more frequently than your regular veterinarian, and many times the pet should have 24 hour (around the clock) monitoring and treatment to have the best chance for a successful outcome.

It used to be that veterinary schools were the only alternative when such procedures needed to be done and clients had to drive hours to the nearest school. Now, most major cities have one or more specialty hospitals. Here is Memphis, we are fortunate to have several board-certified surgeons, internists, an opthamologist, a dermatologist, an oncologist, and a physical therapist. Because they have more advanced expertise and have access to more advanced technology, their fees are higher. Most major cities also have one or more emergency hospitals where pet owners can take their pets when their regular veterinarian is closed during evenings, weekends, and holidays. The emergency hospital's fees are also likely to be higher than your regular veterinarian's fees.

This should at least make you think about the benefits of having pet health insurance for your pet when you are faced with having to visit a specialty hospital or an emergency hospital and a significant veterinary bill.

One of the good things about pet health insurance is that pet owners who have insurance can go to any veterinarian, hospital, specialist and be reimbursed for covered medical expenses. They aren't limited to doctors or hospitals in a "network." This is an important reason that veterinarians and pet owners alike should avoid joining networks typical of the HMOs, PPOs, etc. that is typical of the "managed care" model that plague most human healthcare professions.

Exclusions - Pt. 4

There are miscellaneous exclusions that aren't as important in the big scheme of things as hereditary or chronic conditions or wellness care, but pet owners are occasionally caught by surprise if they aren't aware of them.

 

For example, most companies won’t cover behavioral problems, breeding or pregnancy–related expenses, cosmetic or elective procedures like tail-docking, ear trims, declawing, etc.(not an exhaustive list). I had a client who purchased a policy and when his pregnant dog developed problems, he was very upset because it wasn’t covered. It was clearly stated in the policy, but he likely didn’t even read the policy until his claim was rejected. This is the reason you should research and ask questions before purchasing a policy. One of my goals in writing about pet health insurance is to give readers a heads up on what to look for and what to ask about. Ideally, you should print a copy of a company's policy that your are interested in, carefully read it - highlighting anything you don't clearly understand, and then contact the company to get an explanation. You should never purchase a policy without reading it thoroughly.

Is Wellness Care Coverage Worth It?

 

Pet owners should purchase pet health insurance to cover those unexpected accidents or illnesses where the cost is unknown -- potentially hundreds to thousands of dollars. Coverage for wellness care where the procedures and costs are predictable should be a secondary concern. Since wellness procedures and products can be planned for and saved for, not all insurance companies offer wellness care benefits. Following your veterinarian's recommendations about wellness care is extremely important to your pet's overall health and well-being. Wellness care prevents disease and allows early detection and intervention that saves lives, reduces suffering, and saves you money because prevention inevitably costs significantly less than treatment.

What are we referring to when we say wellness procedures and products? 
- Wellness examinations by your veterinarian 
- Vaccinations for infectious diseases as indicated 
- Intestinal parasite testing 
- Heartworm testing 
- Feline leukemia and AIDs testing 
- Spay and neuter 
- Blood and urine testing for early disease detection screening -especially for senior pets 
- Heartworm preventative medication 
- Flea prevention and treatment medication 
- Dental prophy 

Wellness care procedures and products should not be expensive. However, I know from experience as a veterinarian that many clients don't opt for some of the recommendations I make for their pet. Perhaps cost may be a factor for some clients. It has been my experience that clients are interested in coverage for wellness care. Companies that offer wellness care benefits don't always cover everything in the list above. Pay close attention to what they do cover. Some companies offer different levels of wellness coverage. Some companies advertise almost double in benefits compared to what you pay in premiums. Realize, however, that you likely won't get everything on the list every year. For example, you will only get your pet spayed or neutered once. Some practices are now recommending vaccinating for some diseases every three years instead of annually. The bottom line is that you likely know about what you pay for wellness care annually. I would go through the list above and write down the cost of each procedure or product. If you don't know, call your veterinarian and get an estimate. Then, it is simply a matter of adding up the benefit reimbursements that you would receive for those procedures and products and subtracting the additional premium you pay the company to cover those things and see if you would come out ahead. Sometimes it is hard to estimate accurately.

If a company pays wellness benefits according to a defined benefit schedule (usually listed on their website), it is relatively easy. But, if a company pays according to a schedule of what is usual and customary for your region of the country (usually not listed on their website), it is harder, if not impossible, to determine if you'd come out ahead. The company may not be willing to tell you what the benefit would be for each procedure or product in the list above until you actually file a claim. Sometimes wellness care benefits are subject to your deductible and co-pay. If you haven't used your deductible yet for an illness or injury, your deductible will be subtracted from your wellness benefits. Likewise, if your deductible was applied to your wellness claim, then you wouldn't have a deductible if you filed an illness or injury claim (assuming it is an annual deductible). It is also hard if the company includes wellness care in their accident/illness coverage for one premium (not as a separate rider for an additional premium). You don't know how much of the premium is going for the accident/illness coverage and how much is going for wellness care coverage. In these cases, you may have to actually purchase the wellness care at least one year and see if you think you come out ahead.

In fact, wellness benefits may definitely be worthwhile if purchased for a new puppy or kitten. Some companies now offer generous benefits to cover the complete puppy or kitten vaccination series. This is also the best time to get your pet neutered or spayed which is also covered in most policies as a wellness care benefit. You may also be reimbursed for heartworm preventatives and flea control products. If purchased as a rider, you can always drop the wellness coverage later. If it is included in the policy (not a separate rider), you must be careful and inquire whether changing to another policy (without wellness benefits) later on will affect your accident/illness coverage -especially how pre-existing conditions are handled.

Pet Health Insurance - Exclusions - Pt. 3

 

A chronic condition is a disease that will need long-term (ongoing) treatment after it manifests itself and diagnosis and treatment is started. Many chronic diseases (e.g. diabetes) can be treated and controlled for several years, allowing the pet to live a relatively normal (symptom free) life. 

 

Why is coverage for chronic conditions an important factor to consider when purchasing pet insurance? Because every pet, if they live long enough, will develop one or more chronic conditions that will require ongoing treatment - sometimes for years. Some pets can manifest symptoms of a chronic condition relatively young in life e.g. allergies.

How do companies handle coverage for chronic conditions?

 

• Some don't cover chronic conditions.  For example, if your dog develops diabetes two weeks before your renewal date, the diabetes is only covered for two weeks because when you renew your policy, the company considers the diabetes a pre-existing condition.    
• Some cover chronic conditions, but have limited coverage. Some cover the condition up to the per-incident maximum (total). The per-incident maximum isn't reinstated annually. Pets Best is an example of a company that does this. Lets assume you have their Basic policy which has a $2500 per-incident maximum and your pet develops diabetes. If you spend $1000 this year on diagnosis and treatment, then in the following years, your pet would have $1500 total coverage left for the treatment of the diabetes. Once you've spent $2500 on the diabetes, there isn't anymore coverage for it.  24 PetWatch covers chronic conditions up to the category maximum (total). ASPCA has recently added a chronic conditions optional rider that has its own annual and per-incident maximums and deductible. These limits are less than the normal illness limits in the policy.
• Some cover chronic conditions just like any other illness. Therefore, coverage for all injuries and illnesses (including chronic) combined are covered up to the full per-incident and/or annual maximum which is reinstated every year upon renewal. VPI, PetPlan, and Purina, Trupanion, Embrace and Healthy Paws are companies that do this.
  

You need to know how each company handles coverage for chronic conditions as you choose which company to purchase a policy from. From a veterinarian's perspective, I consider it an important factor because many of the problems that I diagnose and treat are chronic conditions.

After I finish this series of posts on exclusions, I'll try to put it all together in a summary post that will be a very useful tool for you to use in your research. Right now, I'm giving the details of the exclusions I feel are important. Please offer your comments or ask any questions that may come to your mind and I'll try to answer them. 

Pet Health Insurance - Exclusions - Pt. 2

Hereditary conditions are another important exclusion (from a veterinarian's perspective) that some pet insurance companies have in their policies. Some companies totally exclude coverage for any disease or conditions considered hereditary. Others have limited coverage (maximum dollar amounts) that they will pay for some inherited diseases. Others cover inherited conditions just like any other illness in their policies.

Some companies have a list of hereditary conditions available for viewing on their website or in their policy that they don't cover. Generally, if a disease isn't listed, it's covered. Others don't have a published list, but say they use current veterinary texts to determine whether a condition is hereditary or not. 

To realize why I think this is an important factor to consider when choosing a company to insure your pet, take a look at these lists of conditions that are considered hereditary for each breed. The length of the lists may surprise you.

Dogs

Cats

Pet Health Insurance - Exclusions - Part 1

The one exclusion that's virtually universal among pet insurance companies is pre-existing conditions. This means that any problem that your pet has shown symptoms of prior to purchasing an insurance policy or that manifest symptoms during the waiting period prior to the effective date of the policy won't be covered. Waiting periods for accidents and injury usually vary from none to 5 days. Waiting periods for illnesses usually vary from 15 to 30 days. At least one specific problem I know of - anterior cruciate rupture - has a 1- year waiting period with most companies.

Insurance companies go by when you first noticed symptoms, not necessarily when it is diagnosed and treated by a veterinarian. When you apply for coverage, most companies will ask you questions about your pet's medical history. Some may require a copy of your pet's medical records and/or a physical exam by your veterinarian. Some pet owners may be tempted not to tell everything - thinking that if the insurance company doesn't know about a problem, then it will be covered. More than likely, if the insurance company doesn't ask for a copy of your medical records when you apply for coverage, they will when you submit your first claim. If the insurance company finds out you've not been truthful with them, they will cancel your coverage (it's in the fine print of almost any policy). 

If you indicate a previous problem, the company may tell you that specific problem won't be covered and for how long. Some policy language states that if a previous problem hasn't manifested symptoms in 180 days, then it will be covered.  However, if the problem is considered chronic, it likely won't be covered at all. In fact, some chronic problems e.g. Cushings Disease or Diabetes may disqualify your pet from any illness coverage. In this case, your pet would still be eligible for accident/injury coverage.

Therefore, the best time to get insurance for your pet is while he or she is still young before any problems appear. If you know that your pet has had previous problems and you've told the company about it and even submitted past medical records, try to get the insurance company, when they issue a policy, to state in writing what problems aren't covered and for how long. Hopefully, this will prevent surprises from denied claims down the road.