Although I've corresponded with Dr. Carol McConnell via email numerous times and had her as a guest on a podcast episode, I finally got to meet her in person last year at the American Animal Hospital Association (AAHA) meeting in Nashville, TN. We had lunch together and she invited me to visit Veterinary Pet Insurance (VPI).
Earlier this month, my wife and I visited our daughter who lives in Los Angeles and I took advantage of being in the area and visited VPI which is located in Brea, California.
I spent a whole afternoon at VPI headquarters and Dr. McConnell gave me a tour and arranged for me to meet with several members of the team in the customer service, claims, underwriting, and marketing areas. The day ended on a high note when I met with the President of the company, Scott Liles who was gracious enough to stay a little late and spend a few minutes talking about the vision for the future of the company.
VPI is a subsidiary of Nationwide and during 2015, VPI will be transitioning to the Nationwide brand and they are excited about the potential for new products, services and growth.
Dr. McConnell had things so well organized that the time flew by. I'd like to share a few things I learned that might be helpful for the readers who are interested in pet insurance, but especially VPI policyholders.
Claims - VPI presently reimburses claims based on the maximum amount payable annually for primary and secondary diagnoses that are listed on their benefit schedule. Veterinarians aren't required to fill out or sign their claim forms. So, if a case is simple and straight forward e.g. a dog is shaking his head and is diagnosed and treated for an ear infection and nothing else, the owner can put "ear infection" on the claim form, send a copy of the receipt and get a reimbursement that truly reflects what's going on.
Many of VPI's claim adjusters have backgrounds of being trained or working in veterinary practices e.g. veterinary technicians who are familiar with how cases are worked up and diagnosed. VPI doesn't require that medical records pertaining to the visit be sent in at the same time you file a claim. However, if a case is more complicated, they may request the medical record. More complicated claims may be referred to a veterinarian on VPI's staff.
For example, a pet may present to the veterinarian for a complaint of vomiting, and in the process of diagnosing the cause, various tests and procedures may be done that may show abnormalities so that you could end up with a primary diagnosis, along with several different secondary diagnoses. As long as they are covered on VPI's benefit schedule, they will reimburse for each of them. One of the veterinarians who handles more complicated claims showed me a couple of claims he had reviewed recently that demonstrated this.
The bottom line is that unless the case is a simple one, go ahead and ask your veterinarian for copies of the medical record as well as lab reports, etc. and send them in with the claim form. This will likely save time in case the insurance company requests these later in order to process the claim and will also maximize your reimbursement.
Underwriting - these are the folks who review your pet's previous medical history and sometimes medical record to determine if they can cover your pet and/or if there are any pre-existing conditions that won't be covered. When you sign up for a VPI policy, you are asked a pretty extensive list of questions about your pet's past medical history. It is very important that you answer these questions accurately and truthfully.
Some people might inadvertently not remember they took their pet to a different veterinary hospital for a problem when their regular veterinarian was out of town or closed. Or perhaps they took their pet in for an ear infection, but while there they also mentioned a bump they noticed on the skin or the veterinarian noticed a rash during the examination that the owner wasn't aware of, etc. They may not remember all these, but the veterinarian likely made note of them in the medical record. Later, if the insurance company requests the medical records, these will show up and may be classified as pre-existing and not covered.
If your pet has had previous medical problems and the company doesn't request medical records before approving your pet for coverage, consider asking if they will do a medical record review to determine whether any previous conditions your pet has been diagnosed with may be considered pre-existing and not covered down the road.
After answering the list of questions, the underwriter may determine that your pet qualifies for coverage and no other information is needed. Sometimes the answer to one of more questions may cause the insurance company to request a copy of your pet's medical record for more information. If your pet has been diagnosed with certain conditions e.g. cancer or diabetes, he or she likely won't be eligible for coverage for illnesses, but may still qualify for coverage for accidents. When you receive your policy, any conditions identified as not covered by the underwriter will usually be listed.
Yes, there are people who try to get insurance after their pets get sick and don't disclose that on the application. If a person does this, most of the time, they will be found out.
Again, I want to thank Dr. McConnell for the invitation to visit and I hope to also visit all the other pet insurance companies in the United States. The more I learn about them, the more I can share how you can get the most from your pet's insurance policy.
I will be sharing more about VPI/Nationwide and some of the changes that are happening later this year.